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WAL-MART PHARMACY 10-0791
CH0614350 COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
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Covered Entity Details
Entity Name
COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
Subdivision Name
COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
Type
HRSA-Funded Health Center
340B ID
CH0614350
Entity Address
204 E 1st St
Alice, TX 78332-4822
Grant Number
H80CS02323
Participating Start Date
4/1/2004
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0791
Pharmacy Address
2701 E. MAIN
ALICE, TX 78332
Pharmacy Comments
Contract Details
Approval Date
4/12/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Awalt, CEO
(361) 664-0145 Ext: 2024
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/12/2017
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