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Walmart Pharmacy 10-7611
CH062242G Spring Branch Community Health Center
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Covered Entity Details
Entity Name
Spring Branch Community Health Center
Subdivision Name
Spring Branch CHC - NAM Clinic
Type
HRSA-Funded Health Center
340B ID
CH062242G
Entity Address
15555 Kuykendahl Rd
Houston, TX 77090-3651
Grant Number
H80CS06447
Participating Start Date
4/1/2023
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marlen Trujillo, Chief Executive Officer
(713) 462-6565 Ext: 118
Contract Pharmacy Representative
Spring Branch CHC
Marlen Trujillo, Chief Executive Officer
(713) 462-6565 Ext: 118
Signed By Date
10/12/2023
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