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WAL-MART PHARMACY 10-0077
CH061949W LONE STAR CIRCLE OF CARE
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Covered Entity Details
Entity Name
LONE STAR CIRCLE OF CARE
Subdivision Name
Lone Star Circle of Care at Georgetown Women's Center
Type
HRSA-Funded Health Center
340B ID
CH061949W
Entity Address
1900 Scenic Drive STE 3326
Georgetown, TX 78626-7876
Grant Number
H80CS04289
Participating Start Date
7/1/2012
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0077
Pharmacy Address
3701 NORTH MAIN STREET
TAYLOR, TX 76574
Pharmacy Comments
Contract Details
Approval Date
7/13/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jon Calvin, CEO
(512) 686-0523 Ext: 10451
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/13/2024
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