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WAL-MART PHARMACY 10-5713
CH061750 GATEWAY COMMUNITY HEALTH CENTER INC
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Covered Entity Details
Entity Name
GATEWAY COMMUNITY HEALTH CENTER INC
Subdivision Name
GATEWAY COMMUNITY HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH061750
Entity Address
1515 Pappas St
Laredo, TX 78041-1705
Grant Number
H80CS00779
Participating Start Date
12/1/1992
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5713
Pharmacy Address
2615 NE BOB BULLOCK LOOP
LAREDO, TX 78045
Pharmacy Comments
Contract Details
Approval Date
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Elmo S. Lopez Jr., CEO
(956) 625-3001
Contract Pharmacy Representative
Wal-Mart
Marcus Osbourne, VP of Health and Wellness Transformation
(479) 204-9374
Signed By Date
4/15/2016
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