Contract Pharmacy Details

HEB PHARMACY #425
STD782121 Texas Health Action

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

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

4/1/2020
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