Contract Pharmacy Details

CVS PHARMACY, INC.
RWI787520 Waterloo Counseling Center

Covered Entity Details

Entity Name

Waterloo Counseling Center

Subdivision Name

Type

Ryan White Part A

340B ID

RWI787520

Entity Address

314 East Highland Mall Blvd.
Austin, TX 78752

Grant Number

2 H89HA000362400

Participating Start Date

10/1/2018

Last Recertification Date

1/28/2020

Entity Termination Date

4/1/2021

Pharmacy Details

Pharmacy Name

CVS PHARMACY, INC.

Pharmacy Address

DBA: CVS/PHARMACY # 06822
5256 BURNET RD STE B
AUSTIN, TX 78756

Pharmacy Comments

Contract Details

Approval Date

8/27/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Carol L Drennan, Executive Director
(512) 444-9922 Ext: 5124449922

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