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HEB PHARMACY WAREHOUSE 208
FQHCLA487 NAVARRO COUNTY AMBULATORY CARE
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Covered Entity Details
Entity Name
NAVARRO COUNTY AMBULATORY CARE
Subdivision Name
The Dr. Kent E. Rogers Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA487
Entity Address
618 N Main St
Corsicana, TX 75110-3028
Grant Number
LALCS54743
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
HEB PHARMACY WAREHOUSE 208
Pharmacy Address
H-E-B, LP
5311 DIETRICH RD STE 100
SAN ANTONIO, TX 78219
Pharmacy Comments
Contract Details
Approval Date
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marty Summerall, CEO
(903) 874-6731
Contract Pharmacy Representative
HEB
Kimberly Lavrack, Director of Third Party
(210) 938-7344
Signed By Date
4/14/2025
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