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HEB PHARMACY #475
CH061949AR 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 Pflugerville
Type
HRSA-Funded Health Center
340B ID
CH061949AR
Entity Address
1501 W Pecan St Ste 102
Pflugerville, TX 78660-2543
Grant Number
H80CS04289
Participating Start Date
5/5/2021
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
HEB PHARMACY #475
Pharmacy Address
1080 W. HWY 290
ELGIN, TX 78621
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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