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WAL-MART PHARMACY 10-1044
CHC26190-00 TYLER FAMILY CIRCLE OF CARE
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Covered Entity Details
Entity Name
TYLER FAMILY CIRCLE OF CARE
Subdivision Name
Tyler Family Circle of Care - Pediatric Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26190-00
Entity Address
214 E. Houston
Tyler, TX 75702-8131
Grant Number
H80CS26190
Participating Start Date
1/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1044
Pharmacy Address
5050 TROUP HWY
TYLER, TX 75703
Pharmacy Comments
Contract Details
Approval Date
7/13/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/12/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Adams, Chief Executive Officer
(903) 606-5099
Contract Pharmacy Representative
Marc Osbourne, President
(903) 508-6127
Signed By Date
7/13/2016
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