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SULLIVAN PHARMACY
CHC11255-00 Stephen F Austin Community Health Center, Inc
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Covered Entity Details
Entity Name
Stephen F Austin Community Health Center, Inc
Subdivision Name
Stephen F Austin
Type
HRSA-Funded Health Center
340B ID
CHC11255-00
Entity Address
1111 W.Adoue St
Alvin, TX 77511-2718
Grant Number
H80CS11255
Participating Start Date
7/1/2010
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
SULLIVAN PHARMACY
Pharmacy Address
1140 GRAND AVE
BACLIFF, TX 77518
Pharmacy Comments
Contract Details
Approval Date
4/8/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Young, CEO
(281) 824-1480
Contract Pharmacy Representative
Sullivan Pharmacy
Rodolfo Rangel, Owner
(281) 339-4577
Signed By Date
4/8/2025
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