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WAL-MART PHARMACY 10-2123
CH062793S East Texas Border Health Clinic
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Covered Entity Details
Entity Name
East Texas Border Health Clinic
Subdivision Name
Genesis PrimeCare Texarkana-Pediatrics
Type
HRSA-Funded Health Center
340B ID
CH062793S
Entity Address
1411 College Drive
Texarkana, TX 75503-3533
Grant Number
H80CS08781
Participating Start Date
4/1/2021
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2123
Pharmacy Address
4000 NEW BOSTON ROAD
TEXARKANA, TX 75501
Pharmacy Comments
Contract Details
Approval Date
1/9/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carla Roadcap, CEO
(903) 927-3782
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/9/2023
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