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ST. HOPE PHARMACY
RWII77301 ST. HOPE FOUNDATION, INC.
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Covered Entity Details
Entity Name
ST. HOPE FOUNDATION, INC.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII77301
Entity Address
1414 SOUTH FRAZIER #105/106
CONROE, TX 77301
Grant Number
T2-TX
Participating Start Date
4/1/2009
Last Recertification Date
2/14/2020
Entity Termination Date
1/1/2021
Pharmacy Details
Pharmacy Name
ST. HOPE PHARMACY
Pharmacy Address
ST HOPE
6800 WEST LOOP SOUTH
#590
BELLAIRE, TX 77401
Pharmacy Comments
Contract Details
Approval Date
4/16/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Timika Sam-Cooper, Chief Operations Officer
(713) 778-1300 Ext: 2342
Contract Pharmacy Representative
Patrice Bickley, Pharmacy Manager
(713) 778-1300
Signed By Date
4/16/2014
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