Contract Pharmacy Details

HEB PHARMACY #025
CH062390 ATASCOSA HEALTH CENTER, INC.

Covered Entity Details

Entity Name

ATASCOSA HEALTH CENTER, INC.

Subdivision Name

Atascosa Health Center, Inc.

Type

HRSA-Funded Health Center

340B ID

CH062390

Entity Address

310 W Oaklawn Rd
Pleasanton, TX 78064-4033

Grant Number

H80CS00405

Participating Start Date

12/1/1992

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

HEB PHARMACY #025

Pharmacy Address

925 10TH STREET
FLORESVILLE, TX 78114

Pharmacy Comments

Contract Details

Approval Date

4/10/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/13/2016
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Monty Small, CEO
(830) 569-8940 Ext: 2106

Contract Pharmacy Representative

HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578

Signed By Date

4/10/2013

340B Drug Pricing Program Database