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WALMART PHARMACY 10-2765
CH06084A SU CLINICA FAMILIAR
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Covered Entity Details
Entity Name
SU CLINICA FAMILIAR
Subdivision Name
MULTI-SPECIALTY PRIMARY CARE
Type
HRSA-Funded Health Center
340B ID
CH06084A
Entity Address
1706 TREASURE HILLS BLVD
HARLINGEN, TX 78550
Grant Number
H80CS00348
Participating Start Date
12/1/1992
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-2765
Pharmacy Address
1004 W OCEAN BLVD
LOS FRESNOS, TX 78566
Pharmacy Comments
Contract Details
Approval Date
7/18/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ELENA MARIN, CEO
(956) 365-6010 Ext: 1330
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/18/2017
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