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WAL-MART PHARMACY 10-1958
SCH450654-00 STARR COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
STARR COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450654-00
Entity Address
128 N FM 3167
RIO GRANDE CITY, TX 78582-6211
Medicare Provider Number
450654
Participating Start Date
1/1/2018
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1958
Pharmacy Address
4534 EAST HWY 83
RIO GRANDE CITY, TX 78582
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lutano Villarreal, Clinical Operations Director
(956) 487-9074
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/15/2021
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