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WAL-MART PHARMACY 10-0567
CH061223E BRAZOS VALLEY COMMUNITY ACTION AGENCY
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Covered Entity Details
Entity Name
BRAZOS VALLEY COMMUNITY ACTION AGENCY
Subdivision Name
Health Point ABC
Type
HRSA-Funded Health Center
340B ID
CH061223E
Entity Address
1602 rock prairie road
suite 300
COLLEGE STATION, TX 77845
Grant Number
H80CS00299
Participating Start Date
10/1/2013
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0567
Pharmacy Address
475 STATE HIGHWAY 36 NORTH
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
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/15/2021
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