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WAL-MART PHARMACY 10-1303
CH061949L 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 Lake Aire Medical Center
Type
HRSA-Funded Health Center
340B ID
CH061949L
Entity Address
2423 Williams Drive
Georgetown, TX 78628-3200
Grant Number
H80CS04289
Participating Start Date
10/1/2009
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1303
Pharmacy Address
620 S INTERSTATE 35
GEORGETOWN, TX 78628
Pharmacy Comments
Contract Details
Approval Date
6/25/2025
Contract Begin Date
6/25/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jon Calvin, CEO
(512) 549-7519
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
6/25/2025
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