Contract Pharmacy Details

WAL-MART PHARMACY 10-5257
CH093030 ADELANTE HEALTHCARE, INC.

Covered Entity Details

Entity Name

ADELANTE HEALTHCARE, INC.

Subdivision Name

Adelante Healthcare

Type

HRSA-Funded Health Center

340B ID

CH093030

Entity Address

3033 N. Central Ave.
Phoenix, AZ 85012-4403

Grant Number

H80CS00140

Participating Start Date

12/1/1992

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-5257

Pharmacy Address

5122 E UNIVERSITY DR
MESA, AZ 85205

Pharmacy Comments

Contract Details

Approval Date

4/11/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/8/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Eric Battis, COO
(623) 583-3001 Ext: 1222

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

4/11/2018

340B Drug Pricing Program Database