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HEB PHARMACY #236
CH061949AU 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 Mobile Mammography
Type
HRSA-Funded Health Center
340B ID
CH061949AU
Entity Address
2423 Williams Dr
Georgetown, TX 78628-3200
Grant Number
H80CS04289
Participating Start Date
4/1/2022
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
HEB PHARMACY #236
Pharmacy Address
1434 WELLS BRANCH PKWY
PFLUGERVILLE, TX 78660
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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