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WALGREEN CO.
CH061949AA LONE STAR CIRCLE OF CARE
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Covered Entity Details
Entity Name
LONE STAR CIRCLE OF CARE
Subdivision Name
Lone Star Circle of Care
Type
HRSA-Funded Health Center
340B ID
CH061949AA
Entity Address
205 E University Ave Ste 200
Georgetown, TX 78626-6821
Grant Number
H80CS04289
Participating Start Date
7/1/2015
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09808
2612 SMITH ST
HOUSTON, TX 77006
Pharmacy Comments
Contract Details
Approval Date
7/6/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rhonda Mundhenk, CEO
(512) 863-6643 Ext: 10136
Contract Pharmacy Representative
Lone Star Circle of Care
Corbin Ferrell, Director of Pharmacy Operations
(512) 686-0155 Ext: 3
Signed By Date
7/6/2020
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