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WALGREEN CO.
STD78705 Texas Health Action
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Covered Entity Details
Entity Name
Texas Health Action
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD78705
Entity Address
101 W. Koenig Ln
100
Austin, TX 78751
Grant Number
NH25PS005182
Participating Start Date
1/1/2016
Last Recertification Date
5/28/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04704
4501 GUADALUPE ST.
AUSTIN, TX 78751
Pharmacy Comments
Contract Details
Approval Date
10/11/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Benjamin Walker, Executive Director
(281) 799-5475
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2016
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