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WAL-MART PHARMACY 10-0249
CH0627760 HEALTH CENTER OF SOUTHEAST TEXAS
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Covered Entity Details
Entity Name
HEALTH CENTER OF SOUTHEAST TEXAS
Subdivision Name
Health Center of Southeast Texas
Type
HRSA-Funded Health Center
340B ID
CH0627760
Entity Address
307 N. William Barnett Ave.
Cleveland, TX 77327-4061
Grant Number
H80CS08770
Participating Start Date
1/1/2008
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0249
Pharmacy Address
831 HWY. 59 SOUTH
CLEVELAND, TX 77327
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steven Racciato, CEO
(281) 592-2224 Ext: 218
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/13/2020
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