340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-0293
CAH451322-00 Grimes St. Joseph Health Center
Print
Covered Entity Details
Entity Name
Grimes St. Joseph Health Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451322-00
Entity Address
210 S. Judson St
Navasota, TX 77868
Medicare Provider Number
451322
Participating Start Date
1/1/2013
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0293
Pharmacy Address
1712 E. WASHINGTON
NAVASOTA, TX 77868
Pharmacy Comments
Contract Details
Approval Date
2/28/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/25/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ricardo Diaz, Chief Operating Officer
(979) 776-2580
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/15/2013
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session