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WAL-MART PHARMACY 10-0293
CH061223B BRAZOS VALLEY COMMUNITY ACTION AGENCY
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Covered Entity Details
Entity Name
BRAZOS VALLEY COMMUNITY ACTION AGENCY
Subdivision Name
BRYAN COLLEGE STATION CHC
Type
HRSA-Funded Health Center
340B ID
CH061223B
Entity Address
3370 S. TEXAS AVE
Bryan, TX 77802-3127
Grant Number
H80CS00299
Participating Start Date
10/1/2013
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0293
Pharmacy Address
1712 E. WASHINGTON
NAVASOTA, TX 77868
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
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/15/2021
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