Contract Pharmacy Details

CVS PHARMACY, INC.
RWII78752 Vivent Health Texas, Inc.

Covered Entity Details

Entity Name

Vivent Health Texas, Inc.

Subdivision Name

AIDS Services of Austin

Type

Ryan White Part B

340B ID

RWII78752

Entity Address

104 E Highland Mall Blvd
Suite 100
Austin, TX 78752

Grant Number

X07HA00054

Participating Start Date

4/1/2018

Last Recertification Date

2/23/2025

Pharmacy Details

Pharmacy Name

CVS PHARMACY, INC.

Pharmacy Address

DBA: CVS/PHARMACY # 06945
4405 E RIVERSIDE DR
AUSTIN, TX 78741

Pharmacy Comments

Contract Details

Approval Date

7/13/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/4/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Paul Scott, C.E.O.
(512) 458-2437

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/13/2018

340B Drug Pricing Program Database