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WALGREEN CO.
STD78752 Vivent Health Texas, Inc.
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Covered Entity Details
Entity Name
Vivent Health Texas, Inc.
Subdivision Name
AIDS Services of Austin
Type
Sexually Transmitted Diseases
340B ID
STD78752
Entity Address
104 E Highland Mall Blvd
Suite 100
Austin, TX 78752
Grant Number
NH25PS005182
Participating Start Date
7/1/2017
Last Recertification Date
5/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04704
4501 GUADALUPE ST.
AUSTIN, TX 78751
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/2/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Scott, C.E.O.
(512) 458-2437
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2017
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