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HEB PHARMACY #183
CH061949AY 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 Adult Medicine at St. John
Type
HRSA-Funded Health Center
340B ID
CH061949AY
Entity Address
6937 N Interstate 35 STE LoneStar2
Austin, TX 78752-3295
Grant Number
H80CS04289
Participating Start Date
4/1/2024
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
HEB PHARMACY #183
Pharmacy Address
9414 N. LAMAR
AUSTIN, 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
HEB
Kimberly Lavrack, Director of Third Party
(210) 938-7344
Signed By Date
7/12/2024
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