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Walmart Pharmacy 10-7611
CHC24155-00 TEJAS HEALTH CARE
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Covered Entity Details
Entity Name
TEJAS HEALTH CARE
Subdivision Name
Tejas Health Care
Type
HRSA-Funded Health Center
340B ID
CHC24155-00
Entity Address
753 E Travis St
La Grange, TX 78945-2353
Grant Number
H80CS24155
Participating Start Date
1/1/2014
Last Recertification Date
2/17/2025
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
Sheri Kehler, CEO
(979) 968-6596 Ext: 120
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting
(479) 277-3719
Signed By Date
10/12/2023
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