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WALGREEN CO.
RWII779010 Crossroads Virology
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Covered Entity Details
Entity Name
Crossroads Virology
Subdivision Name
Type
Ryan White Part B
340B ID
RWII779010
Entity Address
1403 Victoria Station Dr.
Victoria, TX 77901
Grant Number
X07HA00054
Participating Start Date
7/20/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07964
5204 N NAVARRO ST
VICTORIA, TX 77904
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas A Kaspar, Medical Director
(830) 832-6956
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2020
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