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WAL-MART PHARMACY 10-0461
CH060740 United Medical Centers
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Covered Entity Details
Entity Name
United Medical Centers
Subdivision Name
United Medical Centers Inc.
Type
HRSA-Funded Health Center
340B ID
CH060740
Entity Address
2525 N Veterans Blvd
Eagle Pass, TX 78852-3302
Grant Number
H80CS00643
Participating Start Date
12/1/1992
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0461
Pharmacy Address
496 SOUTH BIBB STREET
EAGLE PASS, TX 78852
Pharmacy Comments
Contract Details
Approval Date
7/22/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
George Kypuros, CEO/Administrator
(830) 773-8917 Ext: 352
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/22/2015
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