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WAL-MART PHARMACY 10-3569
CH061949AA 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
Type
HRSA-Funded Health Center
340B ID
CH061949AA
Entity Address
205 E University Ave Ste 200
Georgetown, TX 78626-6821
Grant Number
H80CS04289
Participating Start Date
7/1/2015
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3569
Pharmacy Address
12900 N I-35 SERVICE RD SB
AUSTIN (NW), TX 78753
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
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/12/2024
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