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Walmart Pharmacy 10-7611
CH0627930 EAST TEXAS BORDER HEALTH CLINIC
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Covered Entity Details
Entity Name
EAST TEXAS BORDER HEALTH CLINIC
Subdivision Name
East Texas Border Health Clinic DBA Genesis Primecare Marshall 2
Type
HRSA-Funded Health Center
340B ID
CH0627930
Entity Address
400 S Alamo Blvd
Marshall, TX 75670-4260
Grant Number
H80CS08781
Participating Start Date
10/1/2007
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/5/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carla Roadcap, CEO
(903) 927-3782
Contract Pharmacy Representative
Walmart
Van Donn, 340B Director Contracting
(479) 273-4000
Signed By Date
10/5/2023
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