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BROOKSHIRE BROTHERS PHARMACY #44
CH061223A BRAZOS VALLEY COMMUNITY ACTION AGENCY
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Covered Entity Details
Entity Name
BRAZOS VALLEY COMMUNITY ACTION AGENCY
Subdivision Name
HealthPoint - Centerville
Type
HRSA-Funded Health Center
340B ID
CH061223A
Entity Address
623 W Lassater St
Centerville, TX 75833
Grant Number
H80CS00299
Participating Start Date
10/1/2013
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
BROOKSHIRE BROTHERS PHARMACY #44
Pharmacy Address
455 HWY 36 N
CALDWELL, TX 77836
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Theresa Sabella, Dr.
(979) 383-2348
Contract Pharmacy Representative
Brookshire Grocery Company
Neil Ducote, Director of Pharmacy
(903) 600-1376
Signed By Date
10/15/2021
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