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WALMART PHARMACY 10-5169
DSH450272 CHRISTUS Santa Rosa Hospital - San Marcos
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Covered Entity Details
Entity Name
CHRISTUS Santa Rosa Hospital - San Marcos
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450272
Entity Address
1301 Wonder World Drive
San Marcos, TX 78666
Medicare Provider Number
450272
Participating Start Date
10/1/2004
Last Recertification Date
8/15/2024
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
4/13/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Chen, CFO
(210) 321-8031
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/13/2023
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