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KROGER PHARMACY #361
CH061223B BRAZOS VALLEY COMMUNITY ACTION AGENCY
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Covered Entity Details
Entity Name
BRAZOS VALLEY COMMUNITY ACTION AGENCY
Subdivision Name
BRYAN COLLEGE STATION CHC
Type
HRSA-Funded Health Center
340B ID
CH061223B
Entity Address
3370 S. TEXAS AVE
Bryan, TX 77802-3127
Grant Number
H80CS00299
Participating Start Date
10/1/2013
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #361
Pharmacy Address
3535 LONGMIRE DRIVE
COLLEGE STATION, TX 77845
Pharmacy Comments
Contract Details
Approval Date
10/11/2024
Contract Begin Date
10/15/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Theresa Sabella, Dr.
(979) 383-2348
Contract Pharmacy Representative
The Kroger Co
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/11/2024
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