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WALMART PHARMACY 10-5169
CH060750 NUESTRA CLINICA DEL VALLE
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Covered Entity Details
Entity Name
NUESTRA CLINICA DEL VALLE
Subdivision Name
NUESTRA CLINICA DEL VALLE, INC.
Type
HRSA-Funded Health Center
340B ID
CH060750
Entity Address
806 West 3rd Street
San Juan, TX 78589-2276
Grant Number
H80CS00209
Participating Start Date
12/1/1992
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LUCY TORRES, CHIEF EXECUTIVE OFFICER
(956) 787-8915 Ext: 231
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/11/2023
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