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WAL-MART PHARMACY 10-1253
CHC24150-00 PEOPLE'S COMMUNITY CLINIC
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Covered Entity Details
Entity Name
PEOPLE'S COMMUNITY CLINIC
Subdivision Name
People's Community Clinic
Type
HRSA-Funded Health Center
340B ID
CHC24150-00
Entity Address
2909 North IH 35
Austin, TX 78722
Grant Number
H80CS24150
Participating Start Date
10/1/2012
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1253
Pharmacy Address
710 EAST BEN WHITE BLVD
AUSTIN, TX 78704
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Regina Rogoff, CEO
(512) 684-1721
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/17/2017
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