Covered Entity Details

CH061949AZ LONE STAR CIRCLE OF CARE (Active) - information as of 4/23/2025 10:55:36 PM

Main Details

Name

LONE STAR CIRCLE OF CARE

Subdivision Name

Lone Star Circle of Care at Harker Heights

Type

HRSA-Funded Health Center

Site ID

BPS-H80-033737

340B ID

CH061949AZ

Grant Number

H80CS04289

Additional Details

Current Program Status

Active

Registration Date

5/29/2024

Participating Start Date

7/1/2024

Participating Approval Date

5/31/2024

Last Recertification Date

2/13/2025

Contacts

Authorizing Official

Lone Star Circle of Care
Jon Calvin, CEO
(512) 686-0523 Ext: 10451

Primary Contact

Lone Star Circle of Care
Corbin Ferrell, Director of Pharmacy Operations
(512) 686-0155 Ext: 3

Addresses

Street Address

401 Cheetah Trl
Harker Heights, TX 76548

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
TX	156057510	1528366648

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13444	120 WEST SLAUGHTER LANE	AUSTIN	TX	78748	07/12/2024	10/01/2024			10/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH061949AA	Active	BPS-H80-014697	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care	205 E University Ave Ste 200	Georgetown	TX
CH061949AB	Active	BPS-H80-017751	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Stassney	730 W Stassney Ln Ste 110	Austin	TX
CH061949AC	Active	BPS-H80-020786	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Northwest Austin	11111 Research Blvd Ste 320	Austin	TX
CH061949AD	Active	BPS-H80-020785	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care OB/GYN at Round Rock	2300 Round Rock Ave Ste 208	Round Rock	TX
CH061949AE	Active	BPS-H80-021009	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Ben White Health Clinic	1221 W Ben White Blvd STE B100	Austin	TX
CH061949AF	Active	BPS-H80-021019	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Ben White Health Clinic	1221 W Ben White Blvd, Bldg B, STE B300	Austin	TX
CH061949AG	Active	BPS-H80-021018	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Northwest Austin	11111 Research Blvd STE 345	Austin	TX
CH061949AH	Terminated	BPS-H80-020856	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Taylor	601A Mallard Ln	Taylor	TX
CH061949AJ	Active	BPS-H80-021427	Lone Star Circle Of Care	Lone Star Circle of Care at Collinfield	8913 Collinfield Dr Unit 1	Austin	TX
CH061949AK	Active	BPS-H80-021902	Lone Star Circle Of Care	Lone Star Circle of Care at Jonestown	18220 FM 1431 STE D	Jonestown	TX
CH061949AL	Terminated	BPS-H80-027483	Lone Star Circle Of Care	Lone Star Circle of Care at the University of Houston	4849 Calhoun Rd Ste 1001A	Houston	TX
CH061949AM	Active	BPS-H80-027705	Lone Star Circle Of Care	Lone Star Circle of Care at El Buen Samaritano	7000 Woodhue Dr Bldg B	Austin	TX
CH061949AN	Active	BPS-H80-029536	Lone Star Circle Of Care	Lone Star Circle of Care at Temple	2112 SW H K Dodgen Loop STE 110	Temple	TX
CH061949AP	Active	BPS-H80-028398	Lone Star Circle Of Care	Lone Star Circle of Care at Cedar Park	1401 Medical Pkwy, BLDG B STE 311	Cedar Park	TX
CH061949AQ	Terminated	BPS-H80-031665	Lone Star Circle Of Care	Lone Star Circle of Care at GISD - Richarte	2295 N Austin Ave STE Hlth Clnc	Georgetown	TX
CH061949AR	Active	BPS-H80-031279	Lone Star Circle Of Care	Lone Star Circle of Care at Pflugerville	1501 W Pecan St Ste 102	Pflugerville	TX
CH061949AS	Active	BPS-H80-032151	Lone Star Circle Of Care	Lone Star Circle of Care OB/GYN at MoPac North	12201 Renfert Way Ste 220	Austin	TX
CH061949AT	Active	BPS-H80-033647	Lone Star Circle Of Care	Lone Star Circle of Care at Taylor	1301 W 4th St	Taylor	TX
CH061949AU	Active	BPS-H80-032030	Lone Star Circle Of Care	Lone Star Circle of Care Mobile Mammography	2423 Williams Dr	Georgetown	TX
CH061949AV	Active	BPS-H80-033573	Lone Star Circle Of Care	Lone Star Circle of Care at Houston Museum District	1200 Binz St Ste 270	Houston	TX
CH061949AW	Active	BPS-H80-034178	Lone Star Circle Of Care	Lone Star Circle of Care at Oak Springs	3000 Oak Springs Dr. STE Lone Star	Austin	TX
CH061949AX	Active	BPS-H80-034200	Lone Star Circle Of Care	Lone Star Circle of Care Pediatrics at MoPac North	12201 Renfert Way STE 105	Austin	TX
CH061949AY	Active	BPS-H80-037284	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care Adult Medicine at St. John	6937 N Interstate 35 STE LoneStar2	Austin	TX
CH061949AZ	Active	BPS-H80-033737	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Harker Heights	401 Cheetah Trl	Harker Heights	TX
CH061949BA	Active	BPS-H80-038860	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at GISD	5001 Airport Rd STE Hlth Clnc	Georgetown	TX
CH061949BB	Active	BPS-H80-039805	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Collinfield	8913 Collinfield Dr. UNIT 2	Austin	TX
CH061949C	Active	BPS-H80-018472	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Georgetown Dental	2411 Williams Dr Ste 111	Georgetown	TX
CH061949F	Active	BPS-H80-005459	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Round Rock Health Clinic	2120 N Mays St STE 430	Round Rock	TX
CH061949G	Terminated	BPS-H80-003095	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care OB/GYN at Round Rock	2300 ROUND ROCK AVE. STE 106	ROUND ROCK	TX
CH061949J	Active	BPS-H80-008193	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Ben White Health Clinic	1221 W Ben White Blvd, Bldg B, STE B200	Austin	TX
CH061949L	Active	BPS-H80-009113	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Lake Aire Medical Center	2423 Williams Drive	Georgetown	TX
CH061949N	Active	BPS-H80-009390	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Texas A&M Health Science Center	3950 North A.W. Grimes Blvd. BLDG 2	Round Rock	TX
CH061949P	Active	BPS-H80-009609	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Hutto	123 Ed Schmidt Blvd. STE 140	Hutto	TX
CH061949Q	Active	BPS-H80-018473	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Whitestone	1730 E Whitestone Blvd Ste 101	Cedar Park	TX
CH061949S	Active	BPS-H80-010264	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Killeen	2300 S Clear Creek Rd STE 105	Killeen	TX
CH061949T	Terminated	BPS-H80-010357	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care Pediatrics at Harker Heights	200 NOLA RUTH	HARKER HEIGHTS	TX
CH061949U	Terminated	BPS-H80-010527	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care Health Center at Taylor	305a Mallard Ln	Taylor	TX
CH061949V	Terminated	BPS-H80-010536	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care Behavioral Health at Harker Heights	775 Indian Trl STE 200	Harker Heights	TX
CH061949W	Active	BPS-H80-011464	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Georgetown Women's Center	1900 Scenic Drive STE 3326	Georgetown	TX
CH061949X	Active	BPS-H80-012351	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Northwest Austin	11111 Research Blvd. STE 295	Austin	TX
CH061949Y	Active	BPS-H80-014496	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Marble Falls	802 Avenue J	Marble Falls	TX
CH061949Z	Active	BPS-H80-014631	LONE STAR CIRCLE OF CARE	Lone Star Circle of Care at Bastrop	605 OLD AUSTIN HWY	BASTROP	TX

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH061949AA	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/01/2024
CH061949AA	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/01/2024
CH061949AA	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/01/2024
CH061949AA	ACCREDO HEALTH GROUP INC	4343 W ROYAL LN STE 124		IRVING	TX	75063-2299	10/01/2024
CH061949AA	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/01/2024
CH061949AA	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/01/2024
CH061949AA	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	10/01/2024
CH061949AA	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	10/01/2024
CH061949AA	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2024
CH061949AA	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2024
CH061949AA	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2024
CH061949AA	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2024
CH061949AA	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2024
CH061949AA	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2024
CH061949AA	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2024
CH061949AA	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2024
CH061949AA	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2024
CH061949AA	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2024
CH061949AA	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2025
CH061949AA	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2025
CH061949AA	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00213	5526 S. CONGRESS AVE.	AUSTIN	TX	78745	10/01/2024
CH061949AA	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01037	1671 HIGHWAY 71 EAST	BASTROP	TX	78602	10/01/2024
CH061949AA	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00116	2001 E. PALM VALLEY BLVD.	ROUND ROCK	TX	78665	10/01/2024
CH061949AA	CVS PHARMACY, INC.	DBA: CVS/PHARMACY #06894	1102 S. AUSTIN AVENUE	GEORGETOWN	TX	78626	10/01/2024
CH061949AA	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07827	1855 GATTIS SCHOOL RD	ROUND ROCK	TX	78664	10/01/2024
CH061949AK	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07827	1855 GATTIS SCHOOL RD	ROUND ROCK	TX	78664	10/01/2024
CH061949AA	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00357	1701 E. PARMER LN.	AUSTIN	TX	78754	04/01/2025
CH061949AA	CVS PHARMACY, INC.	DBA CVS/PHARMACY #10059	4500 ROSS ROAD	DEL VALLE	TX	78617	04/01/2025
CH061949AA	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2024
CH061949AA	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/01/2025
CH061949AF	HEB PHARMACY #091	2508 E RIVERSIDE DRIVE		AUSTIN	TX	78741	10/01/2024
CH061949AA	HEB PHARMACY #091	2508 E RIVERSIDE DRIVE		AUSTIN	TX	78741	10/01/2024
CH061949AG	HEB PHARMACY #161	7112 ED BLUESTEIN		AUSTIN	TX	78723	10/01/2024
CH061949AA	HEB PHARMACY #161	7112 ED BLUESTEIN		AUSTIN	TX	78723	10/01/2024
CH061949AA	HEB PHARMACY #183	9414 N. LAMAR		AUSTIN	TX	78753	10/01/2024
CH061949AY	HEB PHARMACY #183	9414 N. LAMAR		AUSTIN	TX	78753	10/01/2024
CH061949AA	HEB PHARMACY #229	6607 IH-35 SOUTH		AUSTIN	TX	78744	10/01/2024
CH061949AM	HEB PHARMACY #229	6607 IH-35 SOUTH		AUSTIN	TX	78744	10/01/2024
CH061949AA	HEB PHARMACY #236	1434 WELLS BRANCH PKWY		PFLUGERVILLE	TX	78660	10/01/2024
CH061949AU	HEB PHARMACY #236	1434 WELLS BRANCH PKWY		PFLUGERVILLE	TX	78660	10/01/2024
CH061949AA	HEB PHARMACY #465	2701 E 7TH ST		AUSTIN	TX	78702	10/01/2024
CH061949AR	HEB PHARMACY #475	1080 W. HWY 290		ELGIN	TX	78621	10/01/2024
CH061949AA	HEB PHARMACY #475	1080 W. HWY 290		ELGIN	TX	78621	10/01/2024
CH061949AN	HEB PHARMACY #476	500 CANYON RIDGE DRIVE		AUSTIN	TX	78753	10/01/2024
CH061949AA	HEB PHARMACY #476	500 CANYON RIDGE DRIVE		AUSTIN	TX	78753	10/01/2024
CH061949AA	HEB PHARMACY #479	201 N FM 685		PFLUGERVILLE	TX	78660	10/01/2024
CH061949AD	HEB PHARMACY #495	603-A LOUIS HENNA		ROUND ROCK	TX	78664	10/01/2024
CH061949AA	HEB PHARMACY #495	603-A LOUIS HENNA		ROUND ROCK	TX	78664	10/01/2024
CH061949AA	HEB PHARMACY #582	104 HASLER BLVD.		BASTROP	TX	78602	10/01/2024
CH061949Z	HEB PHARMACY #582	104 HASLER BLVD.		BASTROP	TX	78602	10/01/2024
CH061949AA	HEB PHARMACY #591	1700 EAST PALM VALLEY BLVD		ROUND ROCK	TX	78664	10/01/2024
CH061949F	HEB PHARMACY #591	1700 EAST PALM VALLEY BLVD		ROUND ROCK	TX	78664	10/01/2024
CH061949AA	HEB PHARMACY #592	651 NORTH US HIGHWAY 183		LEANDER	TX	78641	10/01/2024
CH061949AP	HEB PHARMACY #592	651 NORTH US HIGHWAY 183		LEANDER	TX	78641	10/01/2024
CH061949AA	HEB PHARMACY #593	100 CARLOS G. PARKER BLVD NW	SUITE 101	TAYLOR	TX	76574	10/01/2024
CH061949N	HEB PHARMACY #593	100 CARLOS G. PARKER BLVD NW	SUITE 101	TAYLOR	TX	76574	10/01/2024
CH061949AA	HEB PHARMACY #639	1801 EAST 51ST STREET		AUSTIN	TX	78723	10/01/2024
CH061949AA	HEB PHARMACY #710	8801 S CONGRESS AVE		AUSTIN	TX	78745-7389	10/01/2024
CH061949AA	HEB PHARMACY #781	1010 W. UNIVERSITY AVE		GEORGETOWN	TX	78628	10/01/2024
CH061949L	HEB PHARMACY #781	1010 W. UNIVERSITY AVE		GEORGETOWN	TX	78628	10/01/2024
CH061949AA	HEB PHARMACY WAREHOUSE 208	H-E-B, LP	5311 DIETRICH RD STE 100	SAN ANTONIO	TX	78219	10/01/2024
CH061949AA	HEB SPECIALTY PHARMACY #701	3503 FREDERICKSBURG RD	STE 450	SAN ANTONIO	TX	78201	10/01/2024
CH061949AA	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2024
CH061949AA	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2024
CH061949AA	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2024
CH061949AA	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2024
CH061949AA	WAL-MART PHARMACY 10-0077	3701 NORTH MAIN STREET		TAYLOR	TX	76574	10/01/2024
CH061949W	WAL-MART PHARMACY 10-0077	3701 NORTH MAIN STREET		TAYLOR	TX	76574	10/01/2024
CH061949AA	WAL-MART PHARMACY 10-0475	2701 SOUTH I.H. 35		ROUND ROCK	TX	78664	10/01/2024
CH061949AX	WAL-MART PHARMACY 10-1042	488 HIGHWAY 71 WEST		BASTROP	TX	78602	10/01/2024
CH061949AA	WAL-MART PHARMACY 10-1042	488 HIGHWAY 71 WEST		BASTROP	TX	78602	10/01/2024
CH061949AA	WAL-MART PHARMACY 10-1253	710 EAST BEN WHITE BLVD		AUSTIN	TX	78704	10/01/2024
CH061949C	WAL-MART PHARMACY 10-1303	620 SOUTH IH 35		GEORGETOWN	TX	78626	10/01/2024
CH061949AA	WAL-MART PHARMACY 10-1303	620 SOUTH IH 35		GEORGETOWN	TX	78626	10/01/2024
CH061949AA	WAL-MART PHARMACY 10-2133	5017 U.S. HIGHWAY 290 WEST		AUSTIN (MID W)	TX	78735	10/01/2024
CH061949AA	WAL-MART PHARMACY 10-3569	12900 N I-35 SERVICE RD SB		AUSTIN (NW)	TX	78753	10/01/2024
CH061949AA	WAL-MART PHARMACY 10-5317	9300 SOUTH IH-35 BLDG. "B"		AUSTIN	TX	78748	10/01/2024
CH061949AA	WAL-MART PHARMACY 10-5480	4700 EAST PALM VALLEY BLVD		ROUND ROCK (NE)	TX	78664	10/01/2024
CH061949AA	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2024
CH061949L	WALGREEN CO.	DBA: WALGREENS # 06158	3614 S 31ST ST	TEMPLE	TX	76502	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 10392	100 LAKE ROAD	BELTON	TX	76513-1510	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #11273	527 E BUSINESS 190	COPPERAS COVE	TX	76522	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #10711	1000 E. CENTRAL TEXAS EXPY.	KILLEEN	TX	76541-9162	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #11130	3802 E. ELMS RD.	KILLEEN	TX	76542-8542	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 10730	400 E FM 2410 RD	HARKER HEIGHTS	TX	76548	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 09680	1610 N MAIN STREET	TAYLOR	TX	76574	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #13588	4201 HIGHWAY 71 E	BASTROP	TX	78602	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 03342	710 N. BELL BLVD	CEDAR PARK	TX	78613	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 06517	1495 CYPRESS CREEK RD	CEDAR PARK	TX	78613	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 07061	1505 W WHITESTONE BLVD	CEDAR PARK	TX	78613	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 06912	3204 WILLIAMS DRIVE	GEORGETOWN	TX	78628	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #11566	119 ED SCHMIDT BLVD.	HUTTO	TX	78634	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 07674	905 CRYSTAL FALLS PKWY	LEANDER	TX	78641	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 09366	1211 N US HWY 281	MARBLE FALLS	TX	78654-4501	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 03159	2021 W PECAN ST	PFLUGERVILLE	TX	78660	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #11568	1821 FM 685	PFLUGERVILLE	TX	78660	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #13446	1509 E. WELLS BRANCH PKWY.	PFLUGERVILLE	TX	78660	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 04823	901 E. PALM VALLEY BOULEVARD	ROUND ROCK	TX	78664	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 10232	4550 E PALM VALLEY BLVD	ROUND ROCK	TX	78665	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 07310	799 LOUIS HENNA BLVD	ROUND ROCK	TX	78664-7074	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 07537	3777 GATTIS SCHOOL ROAD	ROUND ROCK	TX	78664-9730	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #10961	4081 N MAYS ST	ROUND ROCK	TX	78665	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 05708	2650 R R 620	ROUND ROCK	TX	78681-5530	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 09216	2220 SOUTH I-35	ROUND ROCK	TX	78681-7900	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 02462	1144 AIRPORT BLVD	AUSTIN	TX	78702	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 01933	2501 S LAMAR BLVD	AUSTIN	TX	78704-4730	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 07673	10600 W PARMER LANE	AUSTIN	TX	78717	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #10615	5345 N INTERSTATE 35	AUSTIN	TX	78723	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 06189	12550 METRIC BLVD	AUSTIN	TX	78727	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 06734	3921 W PARMER LANE	AUSTIN	TX	78727	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 01970	3407 WELLS BRANCH PKWY	AUSTIN	TX	78728	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 05159	7410 MCNEIL DR	AUSTIN	TX	78729	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 06649	6911 RANCH ROAD 620 NORTH	AUSTIN	TX	78732	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #15672	1920 E RIVERSIDE DR BLDG B	AUSTIN	TX	78741	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 03341	5600 SOUTH 1ST STREET	AUSTIN	TX	78745	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 07187	6721 S CONGRESS AVE	AUSTIN	TX	78745-5744	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 06050	3700 BEECAVES RD	WEST LAKE HILLS	TX	78746	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 03724	9801 MANCHACA RD.	AUSTIN	TX	78748	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #13444	120 WEST SLAUGHTER LANE	AUSTIN	TX	78748	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 04761	6200 W.WILLIAM CANNON DR.	AUSTIN	TX	78749	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 04458	3601 W WILLIAM CANNON DR.	AUSTIN	TX	78749	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 04836	11810 RR 620 N	AUSTIN	TX	78750	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #11853	13435 N. HWY. 183 BLDG. 8	AUSTIN	TX	78750	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 04704	4501 GUADALUPE ST.	AUSTIN	TX	78751	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 06861	9307 N LAMAR BLVD	AUSTIN	TX	78753	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 09679	12601 TECH RIDGE BLVD	AUSTIN	TX	78753	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #11271	2525 W. ANDERSON LANE BUILDING 2	AUSTIN	TX	78757	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 04632	1910 #2 W BRAKER LANE	AUSTIN	TX	78758	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 03092	8104 MESA DRIVE	AUSTIN	TX	78759	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 04134	11724 RESEARCH BLVD.	AUSTIN	TX	78759	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 09143	504 STATE HIGHWAY 71 WEST	BASTROP	TX	78602	12/10/2012	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #15140	5317 WILLIAMS DR.	GEORGETOWN	TX	78633	04/01/2013	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #12569	1220 W. UNIVERSITY AVE.	GEORGETOWN	TX	78628	01/01/2014	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #12449	100 N. WATER ST.	BURNET	TX	78611-2445	01/01/2014	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS #10841	1660 MAIN ST.	BUDA	TX	78610	04/01/2015	10/01/2015
CH061949L	WALGREEN CO.	DBA: WALGREENS # 05160	6812 N LAMAR BLVD	AUSTIN	TX	78752	04/01/2015	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 01933	2501 S LAMAR BLVD	AUSTIN	TX	78704-4730	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 01970	3407 WELLS BRANCH PKWY	AUSTIN	TX	78728	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 02462	1144 AIRPORT BLVD	AUSTIN	TX	78702	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 03092	8104 MESA DRIVE	AUSTIN	TX	78759	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 03159	2021 W PECAN ST	PFLUGERVILLE	TX	78660	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 03341	5600 SOUTH 1ST STREET	AUSTIN	TX	78745	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 03342	710 N. BELL BLVD	CEDAR PARK	TX	78613	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 03724	9801 MANCHACA RD.	AUSTIN	TX	78748	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 04134	11724 RESEARCH BLVD.	AUSTIN	TX	78759	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 04458	3601 W WILLIAM CANNON DR.	AUSTIN	TX	78749	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 04632	1910 #2 W BRAKER LANE	AUSTIN	TX	78758	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 04704	4501 GUADALUPE ST.	AUSTIN	TX	78751	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 04761	6200 W.WILLIAM CANNON DR.	AUSTIN	TX	78749	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 04823	901 E. PALM VALLEY BOULEVARD	ROUND ROCK	TX	78664	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 04836	11810 RR 620 N	AUSTIN	TX	78750	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 05159	7410 MCNEIL DR	AUSTIN	TX	78729	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 05160	6812 N LAMAR BLVD	AUSTIN	TX	78752	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 05708	2650 R R 620	ROUND ROCK	TX	78681-5530	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 06050	3700 BEECAVES RD	WEST LAKE HILLS	TX	78746	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 06158	3614 S 31ST ST	TEMPLE	TX	76502	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 06189	12550 METRIC BLVD	AUSTIN	TX	78727	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 06517	1495 CYPRESS CREEK RD	CEDAR PARK	TX	78613	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 06649	6911 RANCH ROAD 620 NORTH	AUSTIN	TX	78732	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 06734	3921 W PARMER LANE	AUSTIN	TX	78727	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 06861	9307 N LAMAR BLVD	AUSTIN	TX	78753	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 06912	3204 WILLIAMS DRIVE	GEORGETOWN	TX	78628	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 07061	1505 W WHITESTONE BLVD	CEDAR PARK	TX	78613	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 07187	6721 S CONGRESS AVE	AUSTIN	TX	78745-5744	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 07310	799 LOUIS HENNA BLVD	ROUND ROCK	TX	78664-7074	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 07537	3777 GATTIS SCHOOL ROAD	ROUND ROCK	TX	78664-9730	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 07673	10600 W PARMER LANE	AUSTIN	TX	78717	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 07674	905 CRYSTAL FALLS PKWY	LEANDER	TX	78641	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 09143	504 STATE HIGHWAY 71 WEST	BASTROP	TX	78602	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 09216	2220 SOUTH I-35	ROUND ROCK	TX	78681-7900	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 09366	1211 N US HWY 281	MARBLE FALLS	TX	78654-4501	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 09679	12601 TECH RIDGE BLVD	AUSTIN	TX	78753	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 09680	1610 N MAIN STREET	TAYLOR	TX	76574	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 10232	4550 E PALM VALLEY BLVD	ROUND ROCK	TX	78665	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 10392	100 LAKE ROAD	BELTON	TX	76513-1510	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #10615	5345 N INTERSTATE 35	AUSTIN	TX	78723	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #10711	1000 E. CENTRAL TEXAS EXPY.	KILLEEN	TX	76541-9162	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 10730	400 E FM 2410 RD	HARKER HEIGHTS	TX	76548	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #10841	1660 MAIN ST.	BUDA	TX	78610	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #10961	4081 N MAYS ST	ROUND ROCK	TX	78665	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #11130	3802 E. ELMS RD.	KILLEEN	TX	76542-8542	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #11271	2525 W. ANDERSON LANE BUILDING 2	AUSTIN	TX	78757	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #11273	527 E BUSINESS 190	COPPERAS COVE	TX	76522	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #11566	119 ED SCHMIDT BLVD.	HUTTO	TX	78634	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #11568	1821 FM 685	PFLUGERVILLE	TX	78660	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #11853	13435 N. HWY. 183 BLDG. 8	AUSTIN	TX	78750	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #12449	100 N. WATER ST.	BURNET	TX	78611-2445	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #12569	1220 W. UNIVERSITY AVE.	GEORGETOWN	TX	78628	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #13444	120 WEST SLAUGHTER LANE	AUSTIN	TX	78748	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #13446	1509 E. WELLS BRANCH PKWY.	PFLUGERVILLE	TX	78660	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #13588	4201 HIGHWAY 71 E	BASTROP	TX	78602	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #15140	5317 WILLIAMS DR.	GEORGETOWN	TX	78633	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #15672	1920 E RIVERSIDE DR BLDG B	AUSTIN	TX	78741	10/01/2015
CH061949AA	WALGREEN CO.	DBA: WALGREENS #12517	5781 KYLE PKWY.	KYLE	TX	78640	04/01/2018
CH061949AA	WALGREEN CO.	DBA: WALGREENS #12029	27495 RANCH ROAD 12	DRIPPING SPRINGS	TX	78620	10/01/2018
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 11465	3822 OLD SPANISH TRAIL	HOUSTON	TX	77021	07/01/2019	01/23/2025
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 02428	2717 FM 1960 RD	HOUSTON	TX	77073	10/01/2020
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 02844	5202 ALMEDA RD	HOUSTON	TX	77004	10/01/2020
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 10477	11633 SHADOW CREEK PKWY	PEARLAND	TX	77584	10/01/2020
CH061949AA	WALGREEN CO.	DBA: WALGREENS #15155	107 W. RANKIN RD.	HOUSTON	TX	77090	10/01/2020
CH061949AA	WALGREEN CO.	DBA: WALGREENS # 09808	2612 SMITH ST	HOUSTON	TX	77006	10/01/2020
CH061949AA	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21228	2500 W. PARMER LN. STE 120	AUSTIN	TX	78727-4232	07/01/2022	08/19/2024
CH061949AW	WALGREEN CO.	DBA: WALGREENS # 09143	504 STATE HIGHWAY 71 WEST	BASTROP	TX	78602	10/01/2024
CH061949AT	WALGREEN CO.	DBA: WALGREENS # 09680	1610 N MAIN STREET	TAYLOR	TX	76574	10/01/2024
CH061949AS	WALGREEN CO.	DBA: WALGREENS # 03724	9801 MANCHACA RD.	AUSTIN	TX	78748	10/01/2024
CH061949AZ	WALGREEN CO.	DBA: WALGREENS #13444	120 WEST SLAUGHTER LANE	AUSTIN	TX	78748	10/01/2024
CH061949AE	WALGREEN CO.	DBA: WALGREENS # 03341	5600 SOUTH 1ST STREET	AUSTIN	TX	78745	10/01/2024
CH061949AC	WALGREEN CO.	DBA: WALGREENS #10615	5345 N INTERSTATE 35	AUSTIN	TX	78723	10/01/2024
CH061949AB	WALGREEN CO.	DBA: WALGREENS # 04458	3601 W WILLIAM CANNON DR.	AUSTIN	TX	78749	10/01/2024
CH061949AJ	WALGREEN CO.	DBA: WALGREENS # 06861	9307 N LAMAR BLVD	AUSTIN	TX	78753	10/01/2024
CH061949P	WALGREEN CO.	DBA: WALGREENS #11566	119 ED SCHMIDT BLVD.	HUTTO	TX	78634	10/01/2024
CH061949S	WALGREEN CO.	DBA: WALGREENS # 04823	901 E. PALM VALLEY BOULEVARD	ROUND ROCK	TX	78664	10/01/2024
CH061949J	WALGREEN CO.	DBA: WALGREENS #15672	1920 E RIVERSIDE DR BLDG B	AUSTIN	TX	78741	10/01/2024
CH061949X	WALGREEN CO.	DBA: WALGREENS # 10232	4550 E PALM VALLEY BLVD	ROUND ROCK	TX	78665	10/01/2024
CH061949Q	WALGREEN CO.	DBA: WALGREENS # 03159	2021 W PECAN ST	PFLUGERVILLE	TX	78660	10/01/2024
CH061949Y	WALGREEN CO.	DBA: WALGREENS # 09366	1211 N US HWY 281	MARBLE FALLS	TX	78654-4501	10/01/2024
CH061949AA	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16468	3701 GUADALUPE ST STE 102	AUSTIN	TX	78705	01/01/2025
CH061949AA	Walgreens #21373	Walgreens Central Fill #21373	4100 Dale Earnhardt Way STE 200	Northlake	TX	76262	01/01/2022
CH061949L	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	07/01/2015
CH061949AA	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/01/2025
CH061949AA	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/01/2025
CH061949AA	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/01/2025
CH061949AA	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/01/2024
CH061949AA	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		2/13/2025 8:55:50 AM	2/13/2025 8:55 AM
Contacts	Primary Contact	Update	AO Change Request	Calvin, Jon CEO Lone Star Circle of Care 5126860523-10451	Ferrell, Corbin Director of Pharmacy Operations Lone Star Circle of Care 5126860155-3	2/12/2025 11:30 AM
Contacts	Authorizing Official	Update	AO Change Request	Ferrell, Corbin Director of Pharmacy Operations Lone Star Circle of Care 5126860155-3	Calvin, Jon CEO Lone Star Circle of Care 5126860523-10451	2/12/2025 11:30 AM
Details	State	Update		Approved	Active	7/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Ferrell, Corbin Director of Pharmacy Operations Lone Star Circle of Care 5126860155-3	5/31/2024 8:48 PM
Details	340B ID	Update	New Registration		CH061949AZ	5/31/2024 8:48 PM
Dates	Participating Approval Date	Update	New Registration		5/31/2024 8:48:13 PM	5/31/2024 8:48 PM
Details	State	Update	New Registration	Pending	Approved	5/31/2024 8:48 PM
Dates	Signed By Date	Update	New Registration		5/29/2024 2:25:21 PM	5/31/2024 8:48 PM
Dates	Start Date	Update	New Registration		7/1/2024 12:00:00 AM	5/31/2024 8:48 PM
Addresses	Main Address	Insert	New Registration		401 Cheetah Trl Harker Heights, TX 76548	5/29/2024 2:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	5/29/2024 2:25 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		156057510	5/29/2024 2:25 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	5/29/2024 2:25 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1528366648	5/29/2024 2:25 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	5/29/2024 2:25 PM
Contacts	Authorizing Official	Insert	New Registration		Ferrell, Corbin Director of Pharmacy Operations Lone Star Circle of Care 5126860155-3	5/29/2024 2:25 PM
Contacts	Primary Contact	Insert	New Registration		Calvin, Jon CEO Lone Star Circle of Care 5126860523-10451	5/29/2024 2:25 PM
Details	Assistance Received From Date	Insert	New Registration			5/29/2024 2:25 PM
Details	Assistance Received To Date	Insert	New Registration			5/29/2024 2:25 PM
Details	Last Recertification Date	Insert	New Registration			5/29/2024 2:25 PM
Details	Grant Number	Insert	New Registration		H80CS04289	5/29/2024 2:25 PM
Details	340B ID	Insert	New Registration			5/29/2024 2:25 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			5/29/2024 2:25 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			5/29/2024 2:25 PM
Details	Medicare Provider Number	Insert	New Registration			5/29/2024 2:25 PM
Details	Entity Name	Insert	New Registration		LONE STAR CIRCLE OF CARE	5/29/2024 2:25 PM
Details	NOFO Number	Insert	New Registration			5/29/2024 2:25 PM
Details	Program Code	Insert	New Registration		CH	5/29/2024 2:25 PM
Details	Entity Subname	Insert	New Registration		Lone Star Circle of Care at Harker Heights	5/29/2024 2:25 PM
Dates	Participating Approval Date	Insert	New Registration			5/29/2024 2:25 PM
Details	State	Insert	New Registration		Pending	5/29/2024 2:25 PM
Dates	Registration Date	Insert	New Registration		5/29/2024 2:25:18 PM	5/29/2024 2:25 PM
Dates	Signed By Date	Insert	New Registration			5/29/2024 2:25 PM
Dates	Start Date	Insert	New Registration			5/29/2024 2:25 PM
Terminations	Termination Comments	Insert	New Registration			5/29/2024 2:25 PM
Terminations	Termination Date	Insert	New Registration			5/29/2024 2:25 PM
Terminations	Termination Effective Date	Insert	New Registration			5/29/2024 2:25 PM
Terminations	Termination Reason	Insert	New Registration			5/29/2024 2:25 PM

340B Drug Pricing Program Database