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WAL-MART PHARMACY 10-0290
SCH450235-00 GONZALES HEALTHCARE SYSTEMS
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Covered Entity Details
Entity Name
GONZALES HEALTHCARE SYSTEMS
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450235-00
Entity Address
1110 N Sarah DeWitt Drive
GONZALES, TX 78629
Medicare Provider Number
450235
Participating Start Date
5/6/2020
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0290
Pharmacy Address
1114 EAST SARAH DEWITT DR.
GONZALES, TX 78629
Pharmacy Comments
Contract Details
Approval Date
5/6/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patty Stewart, Interim CEO
(830) 519-9101
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/28/2020
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