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CEDRA PHARMACY
HV75604 SPECIAL HEALTH RESOURCES FOR TEXAS, INC.
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Covered Entity Details
Entity Name
SPECIAL HEALTH RESOURCES FOR TEXAS, INC.
Subdivision Name
Jim Meyer Comprehensive Health Center
Type
Ryan White Part C
340B ID
HV75604
Entity Address
410 North Fourth Street
LONGVIEW, TX 75601-6511
Grant Number
H76HA01705
Participating Start Date
10/1/2004
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
CEDRA PHARMACY
Pharmacy Address
9669 N CENTRAL EXPY STE 190
DALLAS, TX 75231-5056
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kim Nesvig, CEO
(903) 212-7811 Ext: 7811
Contract Pharmacy Representative
Cedra Pharmacy
Mazen Karnaby, VP Managed Care
(917) 836-8886
Signed By Date
7/17/2018
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