Contract Pharmacy Details

MEDSAVERS PHARMACY
FP78745 EL BUEN SAMARITANO

Covered Entity Details

Entity Name

EL BUEN SAMARITANO

Subdivision Name

El Buen Samaritano

Type

Family Planning (Title X only)

340B ID

FP78745

Entity Address

7000 WOODHUE DRIVE
AUSTIN, TX 78745-5454

Grant Number

FPHPA006401

Participating Start Date

10/1/2015

Last Recertification Date

5/14/2019

Entity Termination Date

10/1/2019

Pharmacy Details

Pharmacy Name

MEDSAVERS PHARMACY

Pharmacy Address

1800 W 35TH ST
AUSTIN, TX 78703

Pharmacy Comments

Contract Details

Approval Date

4/14/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Iliana Gilman, Executive Director
(512) 431-6907

Contract Pharmacy Representative

Chris Johnson, Owner
(512) 465-9292

Signed By Date

4/14/2016