Contract Pharmacy Details

ST HOPE PHARMACY
RWI77301 ST. HOPE FOUNDATION, INC.

Covered Entity Details

Entity Name

ST. HOPE FOUNDATION, INC.

Subdivision Name

Type

Ryan White Part A

340B ID

RWI77301

Entity Address

1414 SOUTH FRAZIER #105/106
CONROE, TX 77301

Grant Number

H89HA00004

Participating Start Date

4/1/2009

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

ST HOPE PHARMACY

Pharmacy Address

ST. HOPE FOUNDATION
1414 S FRAZIER ST STE 105
CONROE, TX 77301

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

2/26/2021
Agreement registered in error

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

340B Drug Pricing Program Database