Contract Pharmacy Details

HEB PHARMACY #425
STD78759 Texas Health Action

Covered Entity Details

Entity Name

Texas Health Action

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD78759

Entity Address

8140 N Mopac Expy
Bldg 2
Ste 130
Austin, TX 78759

Grant Number

NH25PS005182

Participating Start Date

10/1/2018

Last Recertification Date

6/1/2023

Entity Termination Date

10/1/2023

Pharmacy Details

Pharmacy Name

HEB PHARMACY #425

Pharmacy Address

1000 E. 41ST STREET
AUSTIN, TX 78751

Pharmacy Comments

Contract Details

Approval Date

10/15/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Christopher M Hamilton, CEO
(512) 647-6512

Contract Pharmacy Representative

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

Signed By Date

10/15/2019