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WAL-MART PHARMACY 10-0443
CH062120 SOUTH TEXAS RURAL HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
SOUTH TEXAS RURAL HEALTH SERVICES, INC.
Subdivision Name
SOUTH TEXAS RURAL HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH062120
Entity Address
105 SOUTH STEWART STREET
COTULLA, TX 78014-2237
Grant Number
H80CS00361
Participating Start Date
12/1/1992
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0443
Pharmacy Address
109 22ND STREET
HONDO, TX 78861
Pharmacy Comments
Contract Details
Approval Date
11/3/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ALFREDO ZAMORA Jr., CEO
(830) 879-3047 Ext: 206
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
11/3/2017
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