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WAL-MART PHARMACY 10-5997
CH061510 Brownsville Community Health Clinic Corporation
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Covered Entity Details
Entity Name
Brownsville Community Health Clinic Corporation
Subdivision Name
New Horizon Medical Center
Type
HRSA-Funded Health Center
340B ID
CH061510
Entity Address
191 E. Price Rd.
Brownsville, TX 78521-3527
Grant Number
H80CS00717
Participating Start Date
12/1/1992
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
7/14/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/27/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
PAULA S. GOMEZ, CEO
(956) 548-7473
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/14/2015
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