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WAL-MART PHARMACY 10-2069
CH100790 LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC
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Covered Entity Details
Entity Name
LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC
Subdivision Name
PHOENIX HEALTH CENTER--LA CLINICA
Type
HRSA-Funded Health Center
340B ID
CH100790
Entity Address
3617 S Pacific Hwy
Medford, OR 97501-8957
Grant Number
H80CS00759
Participating Start Date
1/1/1999
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2069
Pharmacy Address
1360 CENTER DR.
MEDFORD, OR 97501
Pharmacy Comments
Contract Details
Approval Date
7/7/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brenda Johnson, CEO
(541) 512-3151
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/7/2015
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