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HEB PHARMACY #619
CH061223C BRAZOS VALLEY COMMUNITY ACTION AGENCY
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Covered Entity Details
Entity Name
BRAZOS VALLEY COMMUNITY ACTION AGENCY
Subdivision Name
Grimes County Community HC
Type
HRSA-Funded Health Center
340B ID
CH061223C
Entity Address
8310 State Highway 6
NAVASOTA, TX 77868
Grant Number
H80CS00299
Participating Start Date
10/1/2013
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
HEB PHARMACY #619
Pharmacy Address
949 WILLIAM D. FITCH PKWY
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
HEB
Kimberly Lavrack, Director of Third Party
(210) 938-7344
Signed By Date
10/11/2024
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