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WAL-MART PHARMACY 10-5997
CH068160 HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Waco Family Medicine - Central
Type
HRSA-Funded Health Center
340B ID
CH068160
Entity Address
1600 PROVIDENCE DR
WACO, TX 76707-2261
Grant Number
H80CS00719
Participating Start Date
1/1/2000
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
7/6/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ROLAND A. GOERTZ, CEO
(254) 313-4201
Contract Pharmacy Representative
Wal-Mart
Jodi Prohofsky, Sr. Director, Payer Relations
(254) 301-6601
Signed By Date
7/6/2017
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