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HEB PHARMACY #091
CH061949AF LONE STAR CIRCLE OF CARE
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Covered Entity Details
Entity Name
LONE STAR CIRCLE OF CARE
Subdivision Name
Lone Star Circle of Care at Ben White Health Clinic
Type
HRSA-Funded Health Center
340B ID
CH061949AF
Entity Address
1221 W Ben White Blvd, Bldg B, STE B300
Austin, TX 78704
Grant Number
H80CS04289
Participating Start Date
9/8/2017
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
HEB PHARMACY #091
Pharmacy Address
2508 E RIVERSIDE DRIVE
AUSTIN, TX 78741
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jon Calvin, CEO
(512) 686-0523 Ext: 10451
Contract Pharmacy Representative
HEB
Kimberly Lavrack, Director of Third Party
(210) 938-7344
Signed By Date
7/12/2024
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