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WALMART PHARMACY 10-5169
CH061223D BRAZOS VALLEY COMMUNITY ACTION AGENCY
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Covered Entity Details
Entity Name
BRAZOS VALLEY COMMUNITY ACTION AGENCY
Subdivision Name
ROBERTSON COUNTY COMM HLTH CLIN
Type
HRSA-Funded Health Center
340B ID
CH061223D
Entity Address
1000 W BROWN ST
HEARNE, TX 77859-3063
Grant Number
H80CS00299
Participating Start Date
10/1/2013
Last Recertification Date
2/11/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
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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