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LIFECARE GARZA PHARMACY
RWI78212 BEAT AIDS COALITION TRUST
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Covered Entity Details
Entity Name
BEAT AIDS COALITION TRUST
Subdivision Name
Type
Ryan White Part A
340B ID
RWI78212
Entity Address
208 W EUCLID AVE
SAN ANTONIO, TX 78212
Grant Number
H89HA31891
Participating Start Date
1/1/2017
Last Recertification Date
2/15/2025
Pharmacy Details
Pharmacy Name
LIFECARE GARZA PHARMACY
Pharmacy Address
4500 S PLEASANT VALLEY RD STE 100
AUSTIN, TX 78744
Pharmacy Comments
Contract Details
Approval Date
1/12/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/9/2023
Ownership change
Contacts
Covered Entity Signing Official
MICHELE DURHAM, EXECUTIVE DIRECTOR
(210) 212-2266 Ext: 102
Contract Pharmacy Representative
Gokul Nukala, Pharmacist in Charge
(210) 225-4561
Signed By Date
1/12/2017
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