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WALMART PHARMACY # 10-3170
CH060810 COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.
Subdivision Name
COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.
Type
HRSA-Funded Health Center
340B ID
CH060810
Entity Address
228 Saint George St
Gonzales, TX 78629-3910
Grant Number
H80CS00125
Participating Start Date
12/1/1992
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY # 10-3170
Pharmacy Address
1320 W. HWY 290
ELGIN, TX 78621
Pharmacy Comments
Contract Details
Approval Date
1/18/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rafael De La Paz, CEO
(830) 672-6511 Ext: 2270
Contract Pharmacy Representative
Wal-mart
Laura Levine, Manager Contracting
(479) 204-8550
Signed By Date
1/18/2022
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