Contract Pharmacy Details

WALGREEN CO.
RWII779010 Crossroads Virology

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 SPECIALTY PHARMACY #16485
7302 LOUIS PASTEUR DR STE 104
SAN ANTONIO, TX 78229

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

340B Drug Pricing Program Database