Texas Pharmacy License # 30028
CUSTOM COMPOUNDING PHARMACY LLC
License Information
License Status
Active
License #
30028
Expiration Date
06/30/2017
Date License Issued
06/15/2015
Address
1880 SANTE FE DR STE 200
WEATHERFORD, TX 76086
WEATHERFORD, TX 76086
County
PARKER
Phone
(817) 550-6044
Pharmacy Details
Prior Disciplinary Orders*
No
Class of Pharmacy
Community Sterile Compounding
Type of Ownership
LLC
Type of Pharmacy
Community Independent
# of Hospital beds
* Information relating to disciplinary orders is current as of (30 days prior to this date).
A written request for information regarding prior disciplinary orders may be submitted to the office of the Texas State Board of Pharmacy. Disciplinary orders entered pursuant to Chapter 564 of the Texas Pharmacy Act are confidential and not subject to disclosure.
Employment Information
Pharmacist in Charge
KOONTZ, THOMAS H
Pharmacy Profile ¥
Accessible to disabled persons?
Yes
Participates in the Texas Medicaid program?
No
Participates in the Texas Kids Insurance Program (SKIP)?
No
Translating services (Listed Below If Available)
¥ Please note: The data regarding accessibility, translating services, and insurance participation is self-reported by the license holder and no warranty regarding the information is created. Therefore, neither the State of Texas nor the licensing agency accept any legal liability or responsibility or may be held liable or responsible for the accuracy, completeness, timeliness, or usefulness of this information. Should you have any concern as to the accuracy of the data in this system, please contact the license holder or facility for clarification.
Remedial Plans
Remedial plans (if any) are shown above and subject to removal at the end of the 5th fiscal year after the Board enters the plan.
Services Provided
| No | Nuclear |
| No | Out-Patient Prescriptions |
| Yes | Ship Prescription Out of State |
| No | Class D (Expanded Formulary) |
| No | Class D (Alternative Visit Schedule) |
| Yes | Compounding Sterile-Risk Level Low |
| Yes | Compounding Sterile-Risk Level Med |
| Yes | Compounding Sterile-Risk Level High |
| Yes | Compounding Non-Sterile |
| No | 24 Hour Service |
| No | Closed Door |
| Yes | Compounding, Office Use |
| No | Home Delivery |
| No | Infusion |
| No | Pharmacist Administered Immunizations |
| Yes | Veterinary Prescriptions |
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