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Walmart Pharmacy 10-7611
CH061223A BRAZOS VALLEY COMMUNITY ACTION AGENCY
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Covered Entity Details
Entity Name
BRAZOS VALLEY COMMUNITY ACTION AGENCY
Subdivision Name
HealthPoint - Centerville
Type
HRSA-Funded Health Center
340B ID
CH061223A
Entity Address
623 W Lassater St
Centerville, TX 75833
Grant Number
H80CS00299
Participating Start Date
10/1/2013
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
Theresa Sabella, Dr.
(979) 383-2348
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/12/2023
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