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RWII779010 Crossroads Virology (Active)
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Main Details
Name
Crossroads Virology
Subdivision Name
Type
Ryan White Part B
340B ID
RWII779010
Grant Number
X07HA00054
Additional Details
Current Program Status
Active
Registration Date
7/10/2020
Participating Start Date
7/20/2020
Participating Approval Date
7/20/2020
Last Recertification Date
2/10/2025
Time Period the Assistance was Received
4/1/2020 - 3/31/2026
Contacts
Authorizing Official
Crossroads Virology
Paige A Boehm, Clinic Manager
(361) 571-7956
Primary Contact
Crossroads Virology
Cah-liria Jackson, Clinic Supervisor
(361) 571-7956
Addresses
Street Address
1403 Victoria Station Dr.
Victoria, TX 77901
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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Participating start date effective date from: (4/1/2019) until terminated effective date (4/1/2020), reinstatement effective date: (07/20/20)
07/20/2020
April 2025
April 2025
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