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CVS PHARMACY, INC.
CHC07502-00 Legacy Community Health Services, Inc.
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Covered Entity Details
Entity Name
Legacy Community Health Services, Inc.
Subdivision Name
Legacy Montrose Clinic
Type
HRSA-Funded Health Center
340B ID
CHC07502-00
Entity Address
1415 California St
Houston, TX 77006-2602
Grant Number
H80CS07502
Participating Start Date
10/1/2004
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 05882
10902 BISSONETT RD.
HOUSTON, TX 77099
Pharmacy Comments
Contract Details
Approval Date
1/15/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/13/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Katy Caldwell, Executive Director
(832) 548-5050
Contract Pharmacy Representative
CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467
Signed By Date
1/15/2016
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