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SURGE RX
CHC11255-00 Stephen F Austin Community Health Center, Inc
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Covered Entity Details
Entity Name
Stephen F Austin Community Health Center, Inc
Subdivision Name
Stephen F Austin
Type
HRSA-Funded Health Center
340B ID
CHC11255-00
Entity Address
1111 W.Adoue St
Alvin, TX 77511-2718
Grant Number
H80CS11255
Participating Start Date
7/1/2010
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
SURGE RX
Pharmacy Address
4320 BROADWAY ST
SUITE 110
PEARLAND, TX 77581-4016
Pharmacy Comments
Contract Details
Approval Date
6/8/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
10/1/2024
Contract Comments
Contacts
Covered Entity Signing Official
Mark Young, CEO
(281) 824-1480
Contract Pharmacy Representative
Surge Rx
Jared Williams, PIC
(281) 741-1266
Signed By Date
6/8/2023
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