The Anacacho Limestone was deposited during the Campanian and represents two depositional intervals, one of early Campanian and one of middle Campanian age. These two intervals correspond to periods of major eustatic sea level rise. This study focuses on the molluscan paleontology of the middle Campanian interval in the eastern part of the Anacacho exposure belt in Medina County, Texas. Molluscan assemblages in this area are indicative of inner to mid-shelf environments. No significant reef components are present. These eastern Anacacho deposits are interpreted to represent more offshore, deeper water environments than those to the southwest, where reef and lagoonal deposits have been reported. Analysis of the macrofossil components from these eastern localities has expanded the number of invertebrate species known from the Anacacho Limestone by nearly three-fold. This increase in diversity, based on a small amount of new work, suggests that many more taxa are yet to be identified, particularly in the western part of the exposure belt in Uvalde and Kinney Counties. This paper documents the bivalve and gastropod fauna, discussing and illustrating 24 bivalve taxa and 11 gastropod species. Two new bivalve species are named, Panopea anacachoensis new species and Spondylus siccus new species, and two potentially new gastropod species are identified but not named herein due to inadequate material. This paper expands the distribution of many eastern Gulf Coast and Atlantic Coast taxa westward into Texas and shows strong ties between the Anacacho fauna and that of the Campanian Tar Heel and Bladen Formations of the Black Creek Group in North Carolina. The taxonomic ties between these two areas probably reflect the thorough documentation of the North Carolina fauna, which is the best documented Campanian bivalve fauna in the Gulf or Atlantic Coast regions.