Contract Pharmacy Details

HEB PHARMACY #544
CH061223R Brazos Valley Community Action Agency, Inc.

Covered Entity Details

Entity Name

Brazos Valley Community Action Agency, Inc.

Subdivision Name

BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.

Type

HRSA-Funded Health Center

340B ID

CH061223R

Entity Address

1500 University Dr E
College Station, TX 77840-2600

Grant Number

H80CS00299

Participating Start Date

4/1/2020

Last Recertification Date

2/17/2025

Pharmacy Details

Pharmacy Name

HEB PHARMACY #544

Pharmacy Address

725 EAST VILLA MARIA
SUITE 1300
BRYAN, TX 77802

Pharmacy Comments

Contract Details

Approval Date

7/17/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Theresa Sabella, Dr.
(979) 383-2348

Contract Pharmacy Representative

HEB
Kimberly Lavrack, Director of Third Party
(210) 938-7344

Signed By Date

7/17/2023

340B Drug Pricing Program Database