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Walmart Pharmacy 10-7611
CH060810 COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.
Subdivision Name
COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.
Type
HRSA-Funded Health Center
340B ID
CH060810
Entity Address
228 Saint George St
Gonzales, TX 78629-3910
Grant Number
H80CS00125
Participating Start Date
12/1/1992
Last Recertification Date
2/12/2025
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
Rafael De La Paz, CEO
(830) 672-6511 Ext: 2270
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
10/5/2023
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