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WAL-MART PHARMACY 10-0523
HV75604 SPECIAL HEALTH RESOURCES FOR TEXAS, INC.
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Covered Entity Details
Entity Name
SPECIAL HEALTH RESOURCES FOR TEXAS, INC.
Subdivision Name
Jim Meyer Comprehensive Health Center
Type
Ryan White Part C
340B ID
HV75604
Entity Address
410 North Fourth Street
LONGVIEW, TX 75601-6511
Grant Number
H76HA01705
Participating Start Date
10/1/2004
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0523
Pharmacy Address
4609 NW LOOP 436
CARTHAGE, TX 75633
Pharmacy Comments
Contract Details
Approval Date
4/4/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kim Nesvig, CEO
(903) 212-7811 Ext: 7811
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/4/2017
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