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WALGREEN CO.
CH061949L LONE STAR CIRCLE OF CARE
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Covered Entity Details
Entity Name
LONE STAR CIRCLE OF CARE
Subdivision Name
Lone Star Circle of Care at Lake Aire Medical Center
Type
HRSA-Funded Health Center
340B ID
CH061949L
Entity Address
2423 Williams Drive
Georgetown, TX 78628-3200
Grant Number
H80CS04289
Participating Start Date
10/1/2009
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #13588
4201 HIGHWAY 71 E
BASTROP, TX 78602
Pharmacy Comments
Contract Details
Approval Date
12/10/2012
Contract Begin Date
12/10/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Pete Perialas, CEO
(512) 686-0624
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
12/10/2012
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