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WOODLAKES PHARMACY
RWI78208 San Antonio AIDS Foundation
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Covered Entity Details
Entity Name
San Antonio AIDS Foundation
Subdivision Name
Type
Ryan White Part A
340B ID
RWI78208
Entity Address
818 East Grayson Street
San Antonio, TX 78208-1013
Grant Number
H89HA31891
Participating Start Date
1/1/2013
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WOODLAKES PHARMACY
Pharmacy Address
525 WOODLAND SQUARE BLVD STE 170
SUITE 170
CONROE, TX 77384-2212
Pharmacy Comments
Contract Details
Approval Date
6/29/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Cherise Rohr-Allegrini, Chief Executive Officer
(210) 225-4715 Ext: 122
Contract Pharmacy Representative
Elite Analytics Group, Inc
Rex Green, CEO
(469) 899-2293
Signed By Date
6/29/2021
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