Contract Pharmacy Details

HEB PHARMACY #465
FP78712 The University of Texas at Austin - Dell Medical School

Covered Entity Details

Entity Name

The University of Texas at Austin - Dell Medical School

Subdivision Name

UT Health Austin

Type

Family Planning (Title X only)

340B ID

FP78712

Entity Address

1601 Trinity Street
Austin, TX 78712

Grant Number

FPHPA006401

Participating Start Date

1/1/2019

Last Recertification Date

5/13/2019

Entity Termination Date

10/1/2019

Pharmacy Details

Pharmacy Name

HEB PHARMACY #465

Pharmacy Address

2701 E 7TH ST
AUSTIN, TX 78702

Pharmacy Comments

Contract Details

Approval Date

7/15/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Clay Johnston, Vice President for Medical Affairs and Dean
(512) 495-5000

Contract Pharmacy Representative

HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578

Signed By Date

7/15/2019

340B Drug Pricing Program Database