Contract Pharmacy Details

AMAZON PHARMACY #001
CH032960 WESTSIDE FAMILY HEALTHCARE, INC.

Covered Entity Details

Entity Name

WESTSIDE FAMILY HEALTHCARE, INC.

Subdivision Name

Westside Family Healthcare - Administration Office

Type

HRSA-Funded Health Center

340B ID

CH032960

Entity Address

300 Water Street
Suite 200
Wilmington, DE 19801-5043

Grant Number

H80CS00789

Participating Start Date

4/1/2000

Last Recertification Date

2/25/2025

Pharmacy Details

Pharmacy Name

AMAZON PHARMACY #001

Pharmacy Address

4500 S PLEASANT VALLEY RD STE 201
AUSTIN, TX 78744-2911

Pharmacy Comments

Contract Details

Approval Date

1/10/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/15/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

LOLITA A. LOPEZ, PRESIDENT AND CEO
(302) 656-8292

Contract Pharmacy Representative

PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725

Signed By Date

1/10/2019

340B Drug Pricing Program Database