Covered Entity Details

CHC11298-06 TRAVIS COUNTY HEALTHCARE DISTRICT (Active) - information as of 4/25/2025 5:39:10 PM

Main Details

Name

TRAVIS COUNTY HEALTHCARE DISTRICT

Subdivision Name

CommUnityCare South Austin

Type

HRSA-Funded Health Center

Site ID

BPS-H80-003798

340B ID

CHC11298-06

Grant Number

H80CS11298

Additional Details

Current Program Status

Active

Registration Date

6/25/2009

Participating Start Date

12/1/1992

Participating Approval Date

6/25/2009

Last Recertification Date

2/19/2025

Contacts

Authorizing Official

Central Texas Community Health Centers d.b.a. CommUnityCare Health Centers
Nicholas Yagoda, Imterim CEO
(512) 978-9527

Primary Contact

CommUnityCare Health Centers
Joey Valentino, Pharmacy 340B Program Manager
(512) 978-9083

Addresses

Street Address

2529 S 1st St
Austin, TX 78704-5466

Billing Address

CENTRAL TEXAS COMMUNITY HEALTH CENTERS
2115 Kramer Ln
Ste 100
AUSTIN, TX 78758

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	2046591-01	1780612275

Shipping Addresses

Shipping Address 1

CommUnityCare Central Pharmacy
2901 Montopolis Dr
Austin, TX 78741

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	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00213	5526 S. CONGRESS AVE.	AUSTIN	TX	78745	07/22/2024	10/01/2024			10/01/2024
Contract Detail	DELL SETON MEDICAL CENTER AT THE UNIVERS	1500 RED RIVER ST		AUSTIN	TX	78701-1918	05/02/2006	05/02/2006		02/28/2019	02/28/2019

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CHC11298-00	Active	BPS-H80-015184	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Kramer Administrative Offices	2115 KRAMER LN	STE 100	Austin	TX
CHC11298-01	Active	BPS-H80-002149	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare East Austin	211 Comal St		Austin	TX
CHC11298-02	Terminated	BPS-H80-002778	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Del Valle	3518 FM 973		DEL VALLE	TX
CHC11298-04	Terminated	BPS-H80-000737	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Manor	600 W CARRIE MANOR ST.		MANOR	TX
CHC11298-05	Terminated	BPS-H80-005624	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Pflugerville	15822 FOOTHILL FARMS		PFLUGERVILLE	TX
CHC11298-06	Active	BPS-H80-003798	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare South Austin	2529 S 1st St		Austin	TX
CHC11298-07	Active	BPS-H80-001543	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Oak Hill	8656A HIGHWAY 71 W STE C		AUSTIN	TX
CHC11298-08	Terminated	BPS-H80-005162	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Rosewood-Zaragosa	2802 WEBBERVILLE RD		AUSTIN	TX
CHC11298-09	Active	BPS-H80-002515	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare David Powell	4614 N Interstate 35		Austin	TX
CHC11298-12	Active	BPS-H80-002273	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Austin Resource Center for the Homeless	500 E 7th St		Austin	TX
CHC11298-15	Terminated	BPS-H80-002309	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare RBJ Dental Clinic	15 WALLER ST		AUSTIN	TX
CHC11298-16	Terminated	BPS-H80-001799	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare A.K. Black	928 Blackson Ave		Austin	TX
CHC11298-17	Terminated	BPS-H80-009233	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare University of Texas Children's Wellness Center	5301 H Ross Road		Del Valle	TX
CHC11298-18	Terminated	BPS-H80-004832	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare University of Texas Family Wellness Center	2901 N Interstate 35		Austin	TX
CHC11298-20	Active	BPS-H80-004430	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare William Cannon	6801 S. IH 35 STE 1-E		AUSTIN	TX
CHC11298-21	Active	BPS-H80-008175	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Rundberg	825 E Rundberg Ln STE B1		Austin	TX
CHC11298-22	Terminated	BPS-H80-009598	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Ben White Dental	1221 W. Ben White Blvd		Austin	TX
CHC11298-23	Terminated	BPS-H80-009948	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Women's Health	1313 Red River, Suite 320		Austin	TX
CHC11298-24	Active	BPS-H80-010117	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare - North Central	1210 W Braker Lane		Austin	TX
CHC11298-25	Active	BPS-H80-011026	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Hancock	1000 E. 41st St. BLDG O		Austin	TX
CHC11298-26	Terminated	BPS-H80-010981	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare ATCIC	1631 E. 2nd Street		Austin	TX
CHC11298-27	Terminated	BPS-H80-027052	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare ATCIC Rundberg	825 E. Rundberg Ln	STE E2	Austin	TX
CHC11298-28	Terminated	BPS-H80-012959	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare ATCIC-Dove Springs	5015 South IH-35	Ste 200	Austin	TX
CHC11298-29	Terminated	BPS-H80-013683	TRAVIS COUNTY HEALTHCARE DISTRICT	PES - ATCIC	56 EAST AVE		AUSTIN	TX
CHC11298-30	Active	BPS-H80-014314	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Southeast Health and Wellness Center	2901 Montopolis Dr		Austin	TX
CHC11298-31	Terminated	BPS-H80-014316	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUintyCare Blackstock	1313 RED RIVER ST. Suite 100		AUSTIN	TX
CHC11298-32	Active	BPS-H80-017808	TRAVIS COUNTY HEALTHCARE DISTRICT	Sandra Joy Anderson Community Health and Wellness Center	1705 East 11th Street		AUSTIN	TX
CHC11298-33	Terminated	BPS-H80-021074	TRAVIS COUNTY HEALTHCARE DISTRICT	TEMPORARY SITE: Austin LBJ High School	7309 Lazy Creek Dr		Austin	TX
CHC11298-34	Terminated	BPS-H80-021075	TRAVIS COUNTY HEALTHCARE DISTRICT	TEMPORARY SITE-Austin Tony Burger Center Site	3200 Jones Rd		Austin	TX
CHC11298-35	Terminated	BPS-H80-021076	TRAVIS COUNTY HEALTHCARE DISTRICT	TEMPORARY SITE-Austin Wilhemina Delco Center Site	4601 Pecan Brook Dr.		Austin	TX
CHC11298-36	Terminated	BPS-H80-021077	TRAVIS COUNTY HEALTHCARE DISTRICT	TEMPORARY SITE: Metropolis Shelter	7000 E Metropolis		Austin	TX
CHC11298-37	Active	BPS-H80-021331	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Del Valle	3518 FM 973		DEL VALLE	TX
CHC11298-38	Active	BPS-H80-027321	TRAVIS COUNTY HEALTHCARE DISTRICT	Care Connections Clinic	3706 S 1st St		Austin	TX
CHC11298-39	Active	BPS-H80-021852	TRAVIS COUNTY HEALTHCARE DISTRICT	Community First Health Center	9301 Hog Eye Rd		Austin	TX
CHC11298-40	Active	BPS-H80-022012	TRAVIS COUNTY HEALTHCARE DISTRICT	Riverside Women&s Health Center	2410 E. Riverside Dr. Suite G-2		Austin	TX
CHC11298-41	Active	BPS-H80-022013	TRAVIS COUNTY HEALTHCARE DISTRICT	Springdale Women&s Health Center	7112 Ed Bluestein Blvd Suite 105		Austin	TX
CHC11298-42	Active	BPS-H80-022015	TRAVIS COUNTY HEALTHCARE DISTRICT	Manor Health Center	14008 Shadowglen Blvd STE 302		Manor	TX
CHC11298-43	Active	BPS-H80-022014	TRAVIS COUNTY HEALTHCARE DISTRICT	Bastrop Women&s Health Center	301 Hwy 71 W Suite 111		Bastrop	TX
CHC11298-44	Terminated	BPS-H80-022300	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare at Austin Recovery	13207 Wright Road		Buda	TX
CHC11298-45	Terminated	BPS-H80-022284	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare at Turner Roberts Recreation Center	7201 Colony Loop Dr		Austin	TX
CHC11298-46	Terminated	BPS-H80-022286	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Arbor Terrace	2501 South IH35		Austin	TX
CHC11298-47	Terminated	BPS-H80-022299	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Spring Terrace	7101 N IH-35		Austin	TX
CHC11298-48	ToBeTerminated	BPS-H80-022298	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare at Austin Transitional Center	3154 Texas 71		Austin	TX
CHC11298-49	Active	BPS-H80-024578	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare at Sunrise Church	4430 Manchaca Rd		Austin	TX
CHC11298-50	ToBeTerminated	BPS-H80-027800	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Mobile RV Clinic	7201 Colony Loop Dr		Austin	TX
CHC11298-51	Active	BPS-H80-029647	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Round Rock Family Medicine	1201 S Interstate 35 Ste 303		Round Rock	TX
CHC11298-52	Active	BPS-H80-029644	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Riverside Pediatrics	2237 E Riverside Dr Ste 101C		Austin	TX
CHC11298-53	Active	BPS-H80-029643	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare South Brook Pediatrics	6425 S Interstate 35 Ste 100		Austin	TX
CHC11298-54	Active	BPS-H80-029646	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare North Lamar Pediatrics	9411 N Lamar Blvd Ste 120		Austin	TX
CHC11298-55	Active	BPS-H80-029645	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Springdale Pediatrics	7112 Ed Bluestein Blvd Ste 100		Austin	TX
CHC11298-56	Active	BPS-H80-037843	TRAVIS COUNTY HEALTHCARE DISTRICT	Hornsby Bend Health and Wellness Center	3700 Gilbert Road		Austin	TX
CHC11298-57	Terminated	BPS-H80-030948	TRAVIS COUNTY HEALTHCARE DISTRICT	Temporary Site- CommUnityCare at Prolodge 1 La Quinta	4200 S IH 35		Austin	TX
CHC11298-58	Terminated	BPS-H80-031521	TRAVIS COUNTY HEALTHCARE DISTRICT	Burleson Road	7019 Burleson Rd Bldg 1		Austin	TX
CHC11298-59	Terminated	BPS-H80-031885	TRAVIS COUNTY HEALTHCARE DISTRICT	Temporary Site - CommUnityCare at Rosewood	2802 WEBBERVILLE RD		AUSTIN	TX
CHC11298-60	Active	BPS-H80-031897	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare at Camp Esperanza	780 US Highway 183 S		Austin	TX
CHC11298-61	Active	BPS-H80-031898	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare at Southbridge	2711 S Interstate 35		Austin	TX
CHC11298-62	Active	BPS-H80-036356	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Pflugerville	2700 W Pecan St Ste 450		Pflugerville	TX
CHC11298-63	Active	BPS-H80-035035	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare at Akins High School	10701 S 1st St		Austin	TX
CHC11298-64	Active	BPS-H80-035733	TRAVIS COUNTY HEALTHCARE DISTRICT	Black Men's Health Clinic	6633 E Highway 290 STE 100		Austin	TX
CHC11298-65	Active	BPS-H80-036446	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Chalmers Court	314 Chicon Street		Austin	TX
CHC11298-66	Approved	BPS-H80-039468	TRAVIS COUNTY HEALTHCARE DISTRICT	Capital Plaza - MAT Clinic	5339 N Interstate 35, Ste 100		Austin	TX
CHC11298-67	Approved	BPS-H80-039809	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Del Valle	7050 Elroy Rd		Del Valle	TX
CHC11298-68	Approved	BPS-H80-039937	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Mobile Unit 1	7112 Ed Bluestein Blvd		Austin	TX
CHC11298-69	Approved	BPS-H80-039986	TRAVIS COUNTY HEALTHCARE DISTRICT	CommUnityCare Mobile Care Unit 2	7112 Ed Bluestein Blvd		Austin	TX
CHC11298-70	Approved	BPS-H80-036379	TRAVIS COUNTY HEALTHCARE DISTRICT	The Charlie Center	12675 Research Blvd		Austin	TX

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC11298-00	38TH STREET PHARMACY	711 W 38TH ST STE C3		AUSTIN	TX	78705-1126	01/01/2013
CHC11298-18	38TH STREET PHARMACY	711 W 38TH ST STE C3		AUSTIN	TX	78705-1126	05/19/2010	10/01/2015
CHC11298-00	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/01/2019
CHC11298-00	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/01/2019
CHC11298-00	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/01/2019
CHC11298-00	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/01/2019
CHC11298-00	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	10/01/2019
CHC11298-00	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/01/2019
CHC11298-00	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/01/2024
CHC11298-00	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2024
CHC11298-00	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2020
CHC11298-00	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2020
CHC11298-32	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2024
CHC11298-00	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2024
CHC11298-00	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2024
CHC11298-00	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2024
CHC11298-00	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2024
CHC11298-00	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2024
CHC11298-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2024
CHC11298-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2024
CHC11298-00	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	07/01/2023
CHC11298-00	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	07/01/2023
CHC11298-00	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2023
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00213	5526 S. CONGRESS AVE.	AUSTIN	TX	78745	07/01/2020
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07442	11300 N LAMAR BLVD	AUSTIN	TX	78753	07/01/2020
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00357	1701 E. PARMER LN.	AUSTIN	TX	78754	07/01/2020
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06895	1701 BRIARCLIFF BLVD	AUSTIN	TX	78723	07/01/2020
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06945	4405 E RIVERSIDE DR	AUSTIN	TX	78741	07/01/2020
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07422	920 HWY 80	SAN MARCOS	TX	78666	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA CVS/PHARMACY #10888	500 CONGRESS AVENUE	AUSTIN	TX	78701	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY #06894	1102 S. AUSTIN AVENUE	GEORGETOWN	TX	78626	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06964	2610 LAKE AUSTIN BLVD	AUSTIN	TX	78703	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00116	2001 E. PALM VALLEY BLVD.	ROUND ROCK	TX	78665	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA CVS/PHARMACY #11210	2213 AIRPORT BLVD	AUSTIN	TX	78722	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07474	1609 N. MAIN ST.	TAYLOR	TX	76574	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	CVS/PHARMACY #7210	1950 W WILLIAM CANNON DR	AUSTIN	TX	78745-5323	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 08384	851 S BELL BLVD	CEDAR PARK	TX	78613	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07827	1855 GATTIS SCHOOL RD	ROUND ROCK	TX	78664	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06892	2402 GUADALUPE ST, UNIT B	AUSTIN	TX	78705	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA CVS/PHARMACY #10661	1801 W. PARMER LANE	AUSTIN	TX	78727	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 08322	11725 NORTH FM 620	AUSTIN	TX	78750	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	CVS PHARMACY # 16026	2300 W BEN WHITE BLVD	AUSTIN	TX	78704	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07735	1301 W. PFLUGERVILLE PARKWAY	PFLUGERVILLE	TX	78660	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06822	5256 BURNET RD STE B	AUSTIN	TX	78756	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 04186	1950 BAGDAD RD.	CEDAR PARK	TX	78613	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06893	3569 FAR WEST BLVD.	AUSTIN	TX	78731	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00928	800 WEST OLD SETTLERS BLVD	ROUND ROCK	TX	78681	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00059	4001 W. WILLIAM CANNON DR.	AUSTIN	TX	78749	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 10337	1300 W. US HIGHWAY 290	ELGIN	TX	78621	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	CVS PHARMACY # 16025	8601 RESEARCH BLVD	AUSTIN	TX	78758	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01037	1671 HIGHWAY 71 EAST	BASTROP	TX	78602	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07719	2900 W ANDERSON LN STE 10	AUSTIN	TX	78757	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00080	2306 RR 620 SOUTH	LAKEWAY	TX	78734	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	CVS PHARMACY # 17359	9500 S INTERSTATE 35 STE G	AUSTIN	TX	78748	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 05776	105 WONDERWORLD DRIVE	SAN MARCOS	TX	78666	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01430	2101 S. LAMAR BLVD., UNIT B	AUSTIN	TX	78704	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA CVS/PHARMACY #10486	301 CHRIS KELLEY BLVD.	HUTTO	TX	78634	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	CVS PHARMACY # 17469	10107 RESEARCH BLVD	AUSTIN	TX	78759	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	CVS/PHARMACY # 17713	2021 GUADALUPE ST.	AUSTIN	TX	78705	08/13/2021	11/08/2022
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 03881	520 W. SLAUGHTER LN.	AUSTIN	TX	78748	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 04599	500 NO. BAGDAD RD.	LEANDER	TX	78641	08/13/2021
CHC11298-00	CVS PHARMACY, INC.	DBA CVS/PHARMACY #11199	2113 WELLS BRANCH PARKWAY	AUSTIN	TX	78728	07/01/2023
CHC11298-00	CVS PHARMACY, INC.	CVS PHARMACY # 16920	10900 LAKELINE MALL DR	AUSTIN	TX	78717	07/01/2023
CHC11298-00	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 10106	2013 KELLY LANE	PFLUGERVILLE	TX	78660	07/01/2023
CHC11298-00	CVS PHARMACY, INC.	DBA CVS/PHARMACY #11306	7101 E. WILLIAM CANNON DRIVE	AUSTIN	TX	78744	07/01/2023
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 08357	20601 FM 1431	LAGO VISTA	TX	78645	04/01/2024
CHC11298-00	CVS PHARMACY, INC.	DBA CVS/PHARMACY #17801	901 E. 5TH STREET SUITE 140	AUSTIN	TX	78702	04/01/2024
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07243	3201 BEE CAVES RD #132	AUSTIN	TX	78746	04/01/2024
CHC11298-00	CVS PHARMACY, INC.	DBA CVS/PHARMACY #10059	4500 ROSS ROAD	DEL VALLE	TX	78617	04/01/2024
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 08387	3500 W SLAUGHTER LN	AUSTIN	TX	78749	04/01/2024
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 03505	102 NORTH US 81	KYLE	TX	78640	04/01/2024
CHC11298-06	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00213	5526 S. CONGRESS AVE.	AUSTIN	TX	78745	10/01/2024
CHC11298-51	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07827	1855 GATTIS SCHOOL RD	ROUND ROCK	TX	78664	10/01/2024
CHC11298-40	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06945	4405 E RIVERSIDE DR	AUSTIN	TX	78741	10/01/2024
CHC11298-42	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 10337	1300 W. US HIGHWAY 290	ELGIN	TX	78621	10/01/2024
CHC11298-41	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06895	1701 BRIARCLIFF BLVD	AUSTIN	TX	78723	10/01/2024
CHC11298-62	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00357	1701 E. PARMER LN.	AUSTIN	TX	78754	10/01/2024
CHC11298-20	CVS PHARMACY, INC.	DBA CVS/PHARMACY #11306	7101 E. WILLIAM CANNON DRIVE	AUSTIN	TX	78744	10/01/2024
CHC11298-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 08323	4426 WILLIAMS DR	GEORGETOWN	TX	78628	04/01/2025
CHC11298-00	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	08/13/2021
CHC11298-01	DELL SETON MEDICAL CENTER AT THE UNIVERS	1500 RED RIVER ST		AUSTIN	TX	78701-1918	05/02/2006	02/28/2019
CHC11298-02	DELL SETON MEDICAL CENTER AT THE UNIVERS	1500 RED RIVER ST		AUSTIN	TX	78701-1918	05/02/2006	07/01/2016
CHC11298-04	DELL SETON MEDICAL CENTER AT THE UNIVERS	1500 RED RIVER ST		AUSTIN	TX	78701-1918	05/02/2006	02/28/2019
CHC11298-05	DELL SETON MEDICAL CENTER AT THE UNIVERS	1500 RED RIVER ST		AUSTIN	TX	78701-1918	05/02/2006	02/28/2019
CHC11298-06	DELL SETON MEDICAL CENTER AT THE UNIVERS	1500 RED RIVER ST		AUSTIN	TX	78701-1918	05/02/2006	02/28/2019
CHC11298-07	DELL SETON MEDICAL CENTER AT THE UNIVERS	1500 RED RIVER ST		AUSTIN	TX	78701-1918	05/02/2006	02/28/2019
CHC11298-08	DELL SETON MEDICAL CENTER AT THE UNIVERS	1500 RED RIVER ST		AUSTIN	TX	78701-1918	05/02/2006	04/01/2017
CHC11298-09	DELL SETON MEDICAL CENTER AT THE UNIVERS	1500 RED RIVER ST		AUSTIN	TX	78701-1918	05/02/2006	02/28/2019
CHC11298-12	DELL SETON MEDICAL CENTER AT THE UNIVERS	1500 RED RIVER ST		AUSTIN	TX	78701-1918	05/02/2006	02/28/2019
CHC11298-15	DELL SETON MEDICAL CENTER AT THE UNIVERS	1500 RED RIVER ST		AUSTIN	TX	78701-1918	05/02/2006	10/01/2017
CHC11298-16	DELL SETON MEDICAL CENTER AT THE UNIVERS	1500 RED RIVER ST		AUSTIN	TX	78701-1918	05/02/2006	07/01/2016
CHC11298-00	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/01/2019	07/06/2022
CHC11298-00	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	10/01/2019	07/06/2022
CHC11298-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2019	07/06/2022
CHC11298-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	10/01/2019	07/06/2022
CHC11298-00	H-E-B, LP	H-E-B PHARMACY WAREHOUSE	6520 FRATT RD	SAN ANTONIO	TX	78218	04/01/2014
CHC11298-00	HEB PHARMACY #014	5401 SOUTH FM 1626		KYLE	TX	78640	07/01/2019
CHC11298-00	HEB PHARMACY #031	12860 N. HIGHWAY 183		AUSTIN	TX	78750	07/01/2019
CHC11298-00	HEB PHARMACY #068	5800 W. SLAUGHTER LANE		AUSTIN	TX	78749	01/01/2013
CHC11298-08	HEB PHARMACY #068, LP	HEB PHARMACY #068, LP		Austin	TX	78749	07/26/2011	04/01/2017
CHC11298-00	HEB PHARMACY #091	2508 E RIVERSIDE DRIVE		AUSTIN	TX	78741	01/01/2013
CHC11298-00	HEB PHARMACY #161	7112 ED BLUESTEIN		AUSTIN	TX	78723	01/01/2013
CHC11298-04	HEB PHARMACY #161	7112 ED BLUESTEIN		AUSTIN	TX	78723	04/28/2011	01/01/2022
CHC11298-00	HEB PHARMACY #183	9414 N. LAMAR		AUSTIN	TX	78753	01/01/2013
CHC11298-21	HEB PHARMACY #183	9414 N. LAMAR		AUSTIN	TX	78753	04/28/2011	11/01/2022
CHC11298-00	HEB PHARMACY #202	5808 BURNET RD		AUSTIN	TX	78756	07/01/2019
CHC11298-00	HEB PHARMACY #218	12407 N. MOPAC EXPRESSWAY		AUSTIN	TX	78758	01/01/2013
CHC11298-05	HEB PHARMACY #218	12407 N. MOPAC EXPRESSWAY		AUSTIN	TX	78758	04/27/2011	09/15/2022
CHC11298-00	HEB PHARMACY #227	2110 NEW SLAUGHTER LANE		AUSTIN	TX	78748	01/01/2013
CHC11298-08	HEB PHARMACY #227	2110 NEW SLAUGHTER LANE		AUSTIN	TX	78748	07/26/2011	04/01/2017
CHC11298-00	HEB PHARMACY #229	6607 IH-35 SOUTH		AUSTIN	TX	78744	01/01/2013
CHC11298-20	HEB PHARMACY #229	6607 IH-35 SOUTH		AUSTIN	TX	78744	04/27/2011	09/15/2022
CHC11298-00	HEB PHARMACY #236	1434 WELLS BRANCH PKWY		PFLUGERVILLE	TX	78660	01/01/2013
CHC11298-05	HEB PHARMACY #236	1434 WELLS BRANCH PKWY		PFLUGERVILLE	TX	78660	04/27/2011	09/15/2022
CHC11298-00	HEB PHARMACY #243	641 E. HOPKINS		SAN MARCOS	TX	78666	10/01/2023
CHC11298-00	HEB PHARMACY #265	170 E. WHITESTONE		CEDAR PARK	TX	78613	10/01/2023
CHC11298-00	HEB PHARMACY #269	10710 RESEARCH BLVD, STE 200		AUSTIN	TX	78759	07/01/2019
CHC11298-00	HEB PHARMACY #388	6001 WEST PARMER LN		AUSTIN	TX	78727	07/01/2019
CHC11298-00	HEB PHARMACY #404	12400 STATE HWY 71 WEST SUITE 100		BEE CAVE	TX	78738	07/01/2019
CHC11298-00	HEB PHARMACY #425	1000 E. 41ST STREET		AUSTIN	TX	78751	01/01/2013
CHC11298-08	HEB PHARMACY #425	1000 E. 41ST STREET		AUSTIN	TX	78751	07/26/2011	04/01/2017
CHC11298-00	HEB PHARMACY #428	6900 BRODIE LN		AUSTIN	TX	78745	07/01/2019
CHC11298-00	HEB PHARMACY #445	403 S COLORADO ST		LOCKHART	TX	78644	10/01/2023
CHC11298-00	HEB PHARMACY #451	7301 N. FM 620		AUSTIN	TX	78726	01/01/2013	10/17/2016
CHC11298-00	HEB PHARMACY #451	7301 N. FM 620		AUSTIN	TX	78726	07/01/2019
CHC11298-00	HEB PHARMACY #465	2701 E 7TH ST		AUSTIN	TX	78702	01/01/2013
CHC11298-08	HEB PHARMACY #465	2701 E 7TH ST		AUSTIN	TX	78702	04/27/2011	04/01/2017
CHC11298-00	HEB PHARMACY #475	1080 W. HWY 290		ELGIN	TX	78621	07/01/2019
CHC11298-00	HEB PHARMACY #476	500 CANYON RIDGE DRIVE		AUSTIN	TX	78753	07/01/2019
CHC11298-00	HEB PHARMACY #477	15300 S IH-35		BUDA	TX	78610	07/01/2019
CHC11298-00	HEB PHARMACY #479	201 N FM 685		PFLUGERVILLE	TX	78660	07/01/2019
CHC11298-00	HEB PHARMACY #495	603-A LOUIS HENNA		ROUND ROCK	TX	78664	10/01/2023
CHC11298-00	HEB PHARMACY #582	104 HASLER BLVD.		BASTROP	TX	78602	07/01/2019
CHC11298-00	HEB PHARMACY #591	1700 EAST PALM VALLEY BLVD		ROUND ROCK	TX	78664	10/01/2023
CHC11298-00	HEB PHARMACY #592	651 NORTH US HIGHWAY 183		LEANDER	TX	78641	10/01/2023
CHC11298-00	HEB PHARMACY #639	1801 EAST 51ST STREET		AUSTIN	TX	78723	10/01/2013
CHC11298-00	HEB PHARMACY #659	14028 NORTH US 183		AUSTIN	TX	78717	10/01/2023
CHC11298-00	HEB PHARMACY #696	5000 GATTIS SCHOOL RD		HUTTO	TX	78634	10/01/2023
CHC11298-00	HEB PHARMACY #710	8801 S CONGRESS AVE		AUSTIN	TX	78745-7389	10/01/2020
CHC11298-00	HEB PHARMACY #714	2000 RANCH RD 620 S	STE A	LAKEWAY	TX	78734	07/01/2016
CHC11298-00	HEB PHARMACY #735	1503 HWY 1431 WEST		MARBLE FALLS	TX	78654	10/01/2023
CHC11298-00	HEB PHARMACY #754	2400 S CONGRESS AVE		AUSTIN	TX	78704	01/01/2013
CHC11298-00	HEB PHARMACY #765	7901 W US 290 HWY		AUSTIN	TX	78736	07/01/2019
CHC11298-00	HEB PHARMACY #773	1601 TRINITY ST	BLDG A, SUITE 105	AUSTIN	TX	78712-1765	12/30/2020
CHC11298-00	HEB PHARMACY WAREHOUSE 208	H-E-B, LP	5311 DIETRICH RD STE 100	SAN ANTONIO	TX	78219	07/01/2023
CHC11298-00	HEB SPECIALTY PHARMACY #701	3503 FREDERICKSBURG RD	STE 450	SAN ANTONIO	TX	78201	10/01/2023
CHC11298-00	LAMAR PLAZA DRUG STORE	1509 S LAMAR BLVD STE 550		AUSTIN	TX	78704-2988	04/01/2013
CHC11298-15	LAMAR PLAZA DRUG STORE	1509 S LAMAR BLVD STE 550		AUSTIN	TX	78704-2988	05/19/2010	10/01/2017
CHC11298-00	LEE PHARMACY	LEE PHARMACY	8738 N LAMAR BLVD SUITE C	AUSTIN	TX	78753	04/01/2013	04/17/2015
CHC11298-21	LEE PHARMACY	LEE PHARMACY	8738 N LAMAR BLVD SUITE C	AUSTIN	TX	78753	03/30/2011	04/17/2015
CHC11298-00	MANOR PHARMACY	RSVP HEALTHCARE ALLIANCE, LLC	14008 SHADOW GLEN BLVD STE 102	MANOR	TX	78653	01/01/2022
CHC11298-00	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	10/28/2020	10/13/2021
CHC11298-00	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	04/01/2025
CHC11298-00	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	10/01/2022
CHC11298-00	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	04/01/2025
CHC11298-00	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/28/2020
CHC11298-00	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	10/28/2020
CHC11298-00	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	10/01/2022
CHC11298-00	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	04/01/2025
CHC11298-00	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/01/2025
CHC11298-00	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2022
CHC11298-00	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2020
CHC11298-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #3129	1002 EAST MCDOWELL ROAD	PHOENIX	AZ	85006	08/13/2021
CHC11298-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2024
CHC11298-00	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2024
CHC11298-00	RITE-AWAY PHARMACY & MEDICAL SUPPLY	730 W STASSNEY LN # 160		AUSTIN	TX	78745	10/01/2013	09/30/2022
CHC11298-00	WAL-MART PHARMACY 10-0292	1904 S COLORADO ST.		LOCKHART	TX	78644	01/01/2024
CHC11298-00	WAL-MART PHARMACY 10-1042	488 HIGHWAY 71 WEST		BASTROP	TX	78602	01/01/2024
CHC11298-00	WAL-MART PHARMACY 10-1185	1030 NORWOOD PARK BLVD		AUSTIN	TX	78753	01/01/2024
CHC11298-00	WAL-MART PHARMACY 10-1253	710 EAST BEN WHITE BLVD		AUSTIN	TX	78704	01/01/2024
CHC11298-00	WAL-MART PHARMACY 10-3569	12900 N I-35 SERVICE RD SB		AUSTIN (NW)	TX	78753	01/01/2024
CHC11298-00	WAL-MART PHARMACY 10-4219	690 OLD SAN ANTONIO ROAD		BUDA	TX	78610	01/01/2024
CHC11298-00	WAL-MART PHARMACY 10-4554	2525 W ANDERSON LN.		AUSTIN	TX	78757	01/01/2024
CHC11298-00	WAL-MART PHARMACY 10-5317	9300 SOUTH IH-35 BLDG. "B"		AUSTIN	TX	78748	01/01/2024
CHC11298-00	WAL-MART PHARMACY 10-5479	1548 FM 685		PFLUGERVILLE	TX	78660	01/01/2024
CHC11298-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2024
CHC11298-00	WALGREEN CO.	DBA: WALGREENS # 03341	5600 SOUTH 1ST STREET	AUSTIN	TX	78745	10/01/2023
CHC11298-00	WALGREEN CO.	DBA: WALGREENS #15672	1920 E RIVERSIDE DR BLDG B	AUSTIN	TX	78741	10/01/2023
CHC11298-00	WALGREEN CO.	DBA: WALGREENS #11271	2525 W. ANDERSON LANE BUILDING 2	AUSTIN	TX	78757	10/01/2023
CHC11298-00	WALGREEN CO.	DBA: WALGREENS # 03159	2021 W PECAN ST	PFLUGERVILLE	TX	78660	10/01/2023
CHC11298-00	WALGREEN CO.	DBA: WALGREENS # 01970	3407 WELLS BRANCH PKWY	AUSTIN	TX	78728	10/01/2023
CHC11298-00	WALGREEN CO.	DBA: WALGREENS # 07187	6721 S CONGRESS AVE	AUSTIN	TX	78745-5744	10/01/2023
CHC11298-00	WALGREEN CO.	DBA: WALGREENS # 09679	12601 TECH RIDGE BLVD	AUSTIN	TX	78753	10/01/2023
CHC11298-00	WALGREEN CO.	DBA: WALGREENS # 01933	2501 S LAMAR BLVD	AUSTIN	TX	78704-4730	10/01/2023
CHC11298-00	WALGREEN CO.	DBA: WALGREENS #10615	5345 N INTERSTATE 35	AUSTIN	TX	78723	10/01/2023
CHC11298-00	WALGREEN CO.	DBA: WALGREENS # 06861	9307 N LAMAR BLVD	AUSTIN	TX	78753	10/01/2023
CHC11298-00	WALGREEN CO.	DBA: WALGREENS # 04632	1910 #2 W BRAKER LANE	AUSTIN	TX	78758	10/01/2023
CHC11298-00	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16468	3701 GUADALUPE ST STE 102	AUSTIN	TX	78705	10/01/2023
CHC11298-00	WALGREEN CO.	DBA: WALGREENS # 02462	1144 AIRPORT BLVD	AUSTIN	TX	78702	10/01/2023
CHC11298-00	WALGREEN CO.	DBA: WALGREENS #13446	1509 E. WELLS BRANCH PKWY.	PFLUGERVILLE	TX	78660	07/01/2025
CHC11298-00	WALGREEN CO.	DBA: WALGREENS # 05160	6812 N LAMAR BLVD	AUSTIN	TX	78752	07/01/2025
CHC11298-00	WALGREEN CO.	DBA: WALGREENS #13444	120 WEST SLAUGHTER LANE	AUSTIN	TX	78748	07/01/2025
CHC11298-00	WALGREEN CO.	DBA: WALGREENS # 04761	6200 W.WILLIAM CANNON DR.	AUSTIN	TX	78749	07/01/2025
CHC11298-00	WALGREEN CO.	DBA: WALGREENS # 04704	4501 GUADALUPE ST.	AUSTIN	TX	78751	07/01/2025
CHC11298-00	Walgreens MFC #21373	4100 Dale Earnhardt Way	200	Northlake	TX	76262	10/01/2023
CHC11298-00	WALMART PHARMACY # 10-3169	11923 US HWY 290 E		MANOR	TX	78653	01/01/2024
CHC11298-00	WALMART PHARMACY 10-3585	2901 RILEY FUZZELL RD		SPRING	TX	77386	01/01/2024
CHC11298-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/12/2024 4:53:03 PM	2/19/2025 6:40:15 AM	2/19/2025 6:40 AM
Contacts	Authorizing Official	Update	Change Request	Fournier, Jaeson CEO Central Texas Community Health Centers 5129789050-5125954337	Yagoda, Nicholas Imterim CEO Central Texas Community Health Centers d.b.a. CommUnityCare Health Centers 5129789527	9/20/2024 5:34 PM
Details	Last Recertification Date	Update	Recertification	2/1/2023 10:40:04 AM	2/12/2024 4:53:03 PM	2/12/2024 4:53 PM
Contacts	Primary Contact	Update	Profile Change Request	Valentino, Joey Sr. 340B Program Coordinator CommUnityCare Health Centers 5129789083	Valentino, Joey Pharmacy 340B Program Manager CommUnityCare Health Centers 5129789083	2/1/2024 1:02 PM
Details	Last Recertification Date	Update	Recertification	2/3/2022 10:47:11 AM	2/1/2023 10:40:04 AM	2/1/2023 10:40 AM
Details	Last Recertification Date	Update	Recertification	2/8/2021 12:38:47 PM	2/3/2022 10:47:11 AM	2/3/2022 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/7/2021 3:21 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2046591-01	12/7/2021 3:21 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	12/7/2021 3:21 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1780612275	12/7/2021 3:21 PM
Medicaid Billing	NPI: State	Insert	Change Request		TX	12/7/2021 3:21 PM
Details	Last Recertification Date	Update	Recertification	2/18/2020 8:38:39 AM	2/8/2021 12:38:47 PM	2/8/2021 12:38 PM
Details	Last Recertification Date	Update	Recertification	2/20/2019 1:45:47 PM	2/18/2020 8:38:39 AM	2/18/2020 8:38 AM
Details	Last Recertification Date	Update	Recertification	2/7/2018 3:09:25 PM	2/20/2019 1:45:47 PM	2/20/2019 1:45 PM
Details	Last Recertification Date	Update	Recertification	1/25/2017 12:00:00 AM	2/7/2018 3:09:25 PM	2/7/2018 3:09 PM
Contacts	Primary Contact	Update	Change Request	Klein-Bradham, Kristina Pharmacy Director Central Texas Community Health Center d/b/a CommUnityCare 5129789068	Valentino, Joey Sr. 340B Program Coordinator CommUnityCare Health Centers 5129789083	1/8/2018 11:36 AM
Contacts	Primary Contact	Update		Klein-Bradham, Kristina Pharmacy Director 5129789068	Klein-Bradham, Kristina Pharmacy Director Central Texas Community Health Center d/b/a CommUnityCare 5129789068	9/28/2017 10:21 AM
Contacts	Authorizing Official	Update		Fournier, Jaeson CEO 5129789050	Fournier, Jaeson CEO Central Texas Community Health Centers 5129789050-5125954337	9/20/2017 4:32 PM
Contacts	Authorizing Official	Update		KONECNY, CAROLYN Chief Executive Officer 5129789038	Fournier, Jaeson CEO 5129789050	8/10/2017 2:28 PM
Contacts	Primary Contact	Insert			Klein-Bradham, Kristina Pharmacy Director 5129789068	8/10/2017 2:28 PM
Addresses	Main Address	Insert			2529 S 1st St Austin, TX 78704-5466	8/10/2017 2:25 PM
Addresses	Billing Address	Insert			CENTRAL TEXAS COMMUNITY HEALTH CENTERS 2115 Kramer Ln Ste 100 AUSTIN, TX 78758	8/10/2017 2:25 PM
Addresses	Shipping Address	Insert			CommUnityCare Central Pharmacy 2901 Montopolis Dr Austin, TX 78741	8/10/2017 2:25 PM
Contacts	Authorizing Official	Insert			KONECNY, CAROLYN Chief Executive Officer 5129789038	6/12/2017 1:17 PM
Details	Last Recertification Date	Update		2/26/2016 12:00:00 AM	1/25/2017 12:00:00 AM	1/25/2017 11:33 AM
Details	Last Recertification Date	Update		3/4/2015 12:00:00 AM	2/26/2016 12:00:00 AM	2/26/2016 9:36 AM
Details	Last Recertification Date	Update		3/19/2014 12:00:00 AM	3/4/2015 12:00:00 AM	3/4/2015 2:27 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/19/2014 12:00:00 AM	3/19/2014 5:25 PM
Details	Entity Name	Update		TRAVIS COUNTY HEALTH CARE DISTRICT CENTRAL TEXAS COMMUNITY HEALTH CENTERS	TRAVIS COUNTY HEALTHCARE DISTRICT	3/19/2014 5:25 PM
Details	Entity Subname	Update		SOUTH AUSTIN COMMUNITYCARE	CommUnityCare South Austin	3/19/2014 5:25 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/15/2013 12:12 PM
Dates	Participating Approval Date	Update		6/25/2009 12:24:58 PM	6/25/2009 12:00:00 AM	9/24/2012 2:09 PM
Details	Last Recertification Date	Insert				10/1/2009 1:30 PM
Details	Grant Number	Insert			H80CS11298	10/1/2009 1:30 PM
Details	340B ID	Insert			CHC11298-06	10/1/2009 1:30 PM
Details	Is Authorizing Official EHB Data	Insert				10/1/2009 1:30 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/1/2009 1:30 PM
Details	Medicare Provider Number	Insert				10/1/2009 1:30 PM
Details	Entity Name	Insert			TRAVIS COUNTY HEALTH CARE DISTRICT CENTRAL TEXAS COMMUNITY HEALTH CENTERS	10/1/2009 1:30 PM
Details	Program Code	Insert			CH	10/1/2009 1:30 PM
Details	Entity Subname	Insert			SOUTH AUSTIN COMMUNITYCARE	10/1/2009 1:30 PM
Dates	Participating Approval Date	Insert			6/25/2009 12:24:58 PM	10/1/2009 1:30 PM
Details	State	Insert			Active	10/1/2009 1:30 PM
Dates	Registration Date	Insert			6/25/2009 12:00:00 AM	10/1/2009 1:30 PM
Dates	Signed By Date	Insert				10/1/2009 1:30 PM
Dates	Start Date	Insert			12/1/1992 12:00:00 AM	10/1/2009 1:30 PM
Terminations	Termination Comments	Insert				10/1/2009 1:30 PM
Terminations	Termination Date	Insert				10/1/2009 1:30 PM
Terminations	Termination Effective Date	Insert				10/1/2009 1:30 PM
Terminations	Termination Reason	Insert				10/1/2009 1:30 PM

340B Drug Pricing Program Database