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WALMART PHARMACY 10-5169
CH0627970 AMISTAD COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
AMISTAD COMMUNITY HEALTH CENTER
Subdivision Name
AMISTAD COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0627970
Entity Address
1533 S Brownlee Blvd
Corpus Christi, TX 78404-3131
Grant Number
H80CS08778
Participating Start Date
4/1/2014
Last Recertification Date
2/11/2025
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
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Diane Herrero, CFO
(361) 886-3066
Contract Pharmacy Representative
Amistad Community Health Center Inc
Leo Trevino, Staff Accountant
(361) 886-3033
Signed By Date
10/16/2023
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