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WAL-MART PHARMACY 10-0364
HV00684 Health Horizons of East Texas, Inc.
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Covered Entity Details
Entity Name
Health Horizons of East Texas, Inc.
Subdivision Name
Brown Family Health Center, Inc.
Type
Ryan White Part C
340B ID
HV00684
Entity Address
1407 East Main Street
Nacogdoches, TX 75961
Grant Number
H76HA00684
Participating Start Date
10/1/2011
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0364
Pharmacy Address
765 HURST ST
CENTER, TX 75935-3415
Pharmacy Comments
Contract Details
Approval Date
1/9/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Yolanda Tatum, Executive Director
(936) 569-8240
Contract Pharmacy Representative
Aventi Health
Jeremy Gutierrez, VP Pharmacy Network Development
(210) 365-8494
Signed By Date
1/9/2025
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