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WAL-MART PHARMACY 10-4415
CH067960 PROJECT VIDA HEALTH CENTER
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Covered Entity Details
Entity Name
PROJECT VIDA HEALTH CENTER
Subdivision Name
PROJECT VIDA HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH067960
Entity Address
3607 Rivera
EL PASO, TX 79905-2415
Grant Number
H80CS04287
Participating Start Date
10/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4415
Pharmacy Address
8115 NORTH LOOP
EL PASO, TX 79907
Pharmacy Comments
Contract Details
Approval Date
4/16/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/21/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bill Schlesinger, CEO
(915) 465-1191 Ext: 207
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/16/2017
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