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WAL-MART PHARMACY 10-5332
CH093030 ADELANTE HEALTHCARE, INC.
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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 10-5332
Pharmacy Address
730 E MCKELLIPS RD
MESA (HORNE), AZ 85203
Pharmacy Comments
Contract Details
Approval Date
4/11/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
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
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