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WALMART PHARMACY 10-5169
CH06374F NORTH CENTRAL TEXAS COMMUNITY HEALTH CARE CENTER
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Covered Entity Details
Entity Name
NORTH CENTRAL TEXAS COMMUNITY HEALTH CARE CENTER
Subdivision Name
Pediatric Associates
Type
HRSA-Funded Health Center
340B ID
CH06374F
Entity Address
4420 Kimbell Drive
Wichita Falls, TX 76302-3006
Grant Number
H80CS00553
Participating Start Date
4/1/2018
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
4/4/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Allen Patterson, CEO
(940) 397-2602
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/4/2024
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