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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 # 05388
3923 GARTH RD.
BAYTOWN, TX 77521
Pharmacy Comments
Contract Details
Approval Date
7/11/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Katy Caldwell, Executive Director
(832) 548-5050
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/11/2017
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