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WALMART PHARMACY 10-4373
CH062793H EAST TEXAS BORDER HEALTH CLINIC
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Covered Entity Details
Entity Name
EAST TEXAS BORDER HEALTH CLINIC
Subdivision Name
Genesis PrimeCare-Atlanta
Type
HRSA-Funded Health Center
340B ID
CH062793H
Entity Address
1011 S WILLIAM ST
ATLANTA, TX 75551-3245
Grant Number
H80CS08781
Participating Start Date
1/1/2016
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-4373
Pharmacy Address
200 WAKE VILLAGE RD.
WAKE VILLAGE, 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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