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W5 PHARMACY
CH062237C SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER
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Covered Entity Details
Entity Name
SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER
Subdivision Name
ResourceCare Dental
Type
HRSA-Funded Health Center
340B ID
CH062237C
Entity Address
2802 W Walker St
Breckenridge, TX 76424-4032
Grant Number
H80CS06460
Participating Start Date
12/16/2005
Last Recertification Date
2/12/2025
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
W5 PHARMACY
Pharmacy Address
1110 E WALKER ST
BRECKENRIDGE, TX 76424
Pharmacy Comments
Contract Details
Approval Date
10/3/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/17/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Meagan Marshall, CEO
(325) 762-2447 Ext: 110
Contract Pharmacy Representative
Pharmacy
Cody Wimberley, Director of Pharmacy
(254) 549-7885
Signed By Date
10/3/2024
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