Contract Pharmacy Details

WALGREEN CO.
RWII78752 Vivent Health Texas, Inc.

Covered Entity Details

Entity Name

Vivent Health Texas, Inc.

Subdivision Name

AIDS Services of Austin

Type

Ryan White Part B

340B ID

RWII78752

Entity Address

104 E Highland Mall Blvd
Suite 100
Austin, TX 78752

Grant Number

X07HA00054

Participating Start Date

4/1/2018

Last Recertification Date

2/23/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #16468
3701 GUADALUPE ST STE 102
AUSTIN, TX 78705

Pharmacy Comments

Contract Details

Approval Date

1/12/2018

Contract Begin Date

4/1/2018

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

1/12/2018

340B Drug Pricing Program Database