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Walmart Pharmacy 10-7611
CHC11427-00 Matagorda Episcopal Health Outreach Program
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Covered Entity Details
Entity Name
Matagorda Episcopal Health Outreach Program
Subdivision Name
MEHOP Administration and Outreach
Type
HRSA-Funded Health Center
340B ID
CHC11427-00
Entity Address
101 Ave F N
Bay City, TX 77414-3144
Grant Number
H80CS12889
Participating Start Date
1/1/2010
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tayyab Pasha, DO
(979) 245-2008 Ext: 1121
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
10/13/2023
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