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WAL-MART PHARMACY 10-1078
CH066570 LA ESPERANZA CLINIC, INC.
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Covered Entity Details
Entity Name
LA ESPERANZA CLINIC, INC.
Subdivision Name
LA ESPERANZA CLINIC
Type
HRSA-Funded Health Center
340B ID
CH066570
Entity Address
1610 S Chadbourne St
San Angelo, TX 76903-8510
Grant Number
H80CS00203
Participating Start Date
7/1/1996
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1078
Pharmacy Address
2005 HUTCHINS AVE
BALLINGER, TX 76821
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dean Munn, CEO
(325) 947-5600
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/15/2019
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