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WALGREEN CO.
STD782121 Texas Health Action
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Covered Entity Details
Entity Name
Texas Health Action
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD782121
Entity Address
1219 McCullough
San Antonio, TX 78212
Grant Number
1H25PS004360-02
Participating Start Date
10/1/2017
Last Recertification Date
5/15/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03224
6901 SAN PEDRO AVE
SAN ANTONIO, TX 78216-6206
Pharmacy Comments
Contract Details
Approval Date
10/12/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Christopher M Hamilton, CEO
(512) 647-6512
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/12/2018
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