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Walmart Pharmacy 10-7611
DSH450272 CHRISTUS Santa Rosa Hospital - San Marcos
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Covered Entity Details
Entity Name
CHRISTUS Santa Rosa Hospital - San Marcos
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450272
Entity Address
1301 Wonder World Drive
San Marcos, TX 78666
Medicare Provider Number
450272
Participating Start Date
10/1/2004
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Chen, CFO
(210) 321-8031
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2023
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