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HEB PHARMACY #095
STD75219 Resource Center of Dallas
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Covered Entity Details
Entity Name
Resource Center of Dallas
Subdivision Name
Health Campus
Type
Sexually Transmitted Diseases
340B ID
STD75219
Entity Address
2701 Reagan Street
Dallas, TX 75219
Grant Number
NH25PS005182
Participating Start Date
4/1/2018
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
HEB PHARMACY #095
Pharmacy Address
1911 NE BOB BULLOCK
LAREDO, TX 78045
Pharmacy Comments
Contract Details
Approval Date
1/7/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marisa Elliott, Chief Operating Officer
(214) 540-4454
Contract Pharmacy Representative
HEB
Kimberly Lavrack, Director of Third Party
(210) 938-7344
Signed By Date
1/7/2025
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