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CVS PHARMACY, INC.
STD78759 Texas Health Action
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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
CVS PHARMACY, INC.
Pharmacy Address
DBA CVS/PHARMACY # 5872
22135 IH-10 W
SAN ANTONIO, TX 78257
Pharmacy Comments
Contract Details
Approval Date
1/12/2021
Contract Begin Date
4/1/2021
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
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/12/2021
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