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WALMART PHARMACY 10-4183
CH061223D BRAZOS VALLEY COMMUNITY ACTION AGENCY
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Covered Entity Details
Entity Name
BRAZOS VALLEY COMMUNITY ACTION AGENCY
Subdivision Name
ROBERTSON COUNTY COMM HLTH CLIN
Type
HRSA-Funded Health Center
340B ID
CH061223D
Entity Address
1000 W BROWN ST
HEARNE, TX 77859-3063
Grant Number
H80CS00299
Participating Start Date
10/1/2013
Last Recertification Date
2/11/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-4183
Pharmacy Address
643 N HARVEY MITCHELL PKWY
BRYAN, TX 77807
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
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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