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WAL-MART PHARMACY 10-0456
STD78520 Valley AIDS Council
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Covered Entity Details
Entity Name
Valley AIDS Council
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD78520
Entity Address
857 E Washington
Brownsville, TX 78520
Grant Number
NU62PS924529
Participating Start Date
1/1/2020
Last Recertification Date
5/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0456
Pharmacy Address
3500 WEST ALTON GLOOR BLVD.
BROWNSVILLE, TX 78520
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wally Cantu, Executive Director
(956) 428-2653
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/15/2024
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