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BALLEM PHARMACY
CH065800 SO. CENTRAL HOUSTON ACTION COUNCIL, INC.
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Covered Entity Details
Entity Name
SO. CENTRAL HOUSTON ACTION COUNCIL, INC.
Subdivision Name
MLK
Type
HRSA-Funded Health Center
340B ID
CH065800
Entity Address
8610 MARTIN LUTHER KING, BLVD
HOUSTON, TX 77033
Grant Number
H80CS00204
Participating Start Date
10/1/1998
Last Recertification Date
2/7/2018
Entity Termination Date
1/1/2019
Pharmacy Details
Pharmacy Name
BALLEM PHARMACY
Pharmacy Address
2990 RICHMOND AVE SUITE # 110
HOUSTON, TX 77098
Pharmacy Comments
Contract Details
Approval Date
7/15/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Marcus Roland, CEO
(713) 734-4580
Contract Pharmacy Representative
Clarisa Minang, Owner
(713) 636-9474
Signed By Date
7/15/2015
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