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BROOKSHIRE BROTHERS PHARMACY #65
CH061223R Brazos Valley Community Action Agency, Inc.
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Covered Entity Details
Entity Name
Brazos Valley Community Action Agency, Inc.
Subdivision Name
BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Type
HRSA-Funded Health Center
340B ID
CH061223R
Entity Address
1500 University Dr E
College Station, TX 77840-2600
Grant Number
H80CS00299
Participating Start Date
4/1/2020
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
BROOKSHIRE BROTHERS PHARMACY #65
Pharmacy Address
16800 SH 36 SOUTH
PO BOX 129
SOMERVILLE, TX 77879
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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