Covered Entity Details

CH062245B NORTH TEXAS AREA COMMUNITY HEALTH CENTERS INC (Active) - information as of 4/25/2025 9:20:07 PM

Main Details

Name

NORTH TEXAS AREA COMMUNITY HEALTH CENTERS INC

Subdivision Name

Southeast Community Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-014334

340B ID

CH062245B

Grant Number

H80CS06457

Additional Details

Current Program Status

Active

Registration Date

7/26/2011

Participating Start Date

10/1/2011

Participating Approval Date

9/26/2011

Last Recertification Date

2/24/2025

Contacts

Authorizing Official

North Texas Area Community Health Centers, Inc.
Gerrie Whitaker, CEO
(817) 546-6478

Primary Contact

North Texas Area Community Health Center
Susan Willis, Compliance Officer
(817) 546-6472

Addresses

Street Address

2909 Mitchell Blvd
Fort Worth, TX 76105

Billing Address

North Texas Area Community Health Centers, Inc.
2332 Beverly Hills Drive
Ft Worth, TX 76114-8572

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
TX	220596501	1700192085

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300	SPRING	TX	77386	10/15/2019	01/01/2020	04/01/2022	04/04/2022
Contract Detail	WAL-MART PHARMACY 10-3044	2900 RENAISSANCE SQUARE	FORT WORTH	TX	76105	10/15/2019	01/01/2020	04/01/2022	04/04/2022
Contract Detail	WAL-MART PHARMACY 10-3135	717 WEST BERRY	FORT WORTH	TX	76110	10/15/2019	01/01/2020	04/01/2022	04/04/2022
Contract Detail	WAL-MART PHARMACY 10-5312	3851 AIRPORT FREEWAY	FT WORTH	TX	76111	10/15/2019	01/01/2020	04/01/2022	04/04/2022
Contract Detail	WAL-MART PHARMACY 10-5416	915 EAST RANDOL MILL ROAD	ARLINGTON(N)	TX	76011	10/15/2019	01/01/2020	04/01/2022	04/04/2022
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100	ORLANDO	FL	32837	10/15/2019	01/01/2020	04/01/2022	04/04/2022
Contract Detail	WALMART PHARMACY 10-4165	2245 JACKSBORO HIGHWAY	FORT WORTH	TX	76114	10/15/2019	01/01/2020	04/01/2022	04/04/2022

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH0622450	Active	BPS-H80-024741	NORTH TEXAS AREA COMMUNITY HEALTH CENTERS INC	North Texas Area Community Health Centers, Inc.	2332 Beverly Hills Drive	Fort Worth	TX
CH062245A	Terminated	BPS-H80-002127	NORTH TEXAS AREA COMMUNITY HEALTH CENTERS INC	NORTHSIDE COMMUNITY HEALTH CENTER	2106 N Main St	Fort Worth	TX
CH062245B	Active	BPS-H80-014334	NORTH TEXAS AREA COMMUNITY HEALTH CENTERS INC	Southeast Community Health Center	2909 Mitchell Blvd	Fort Worth	TX
CH062245C	Active	BPS-H80-038814	NORTH TEXAS AREA COMMUNITY HEALTH CENTERS INC	Arlington Community Health Center	1001 N. Waldrop Drive	Arlington	TX

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH0622450	RAY'S TOWN NORTH PHARMACY	ALSABROOK INC	975 N COOPER ST	ARLINGTON	TX	76011	04/01/2019	04/01/2022
CH062245B	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020	04/01/2022
CH0622450	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020	04/01/2022
CH062245C	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020	04/01/2022
CH062245C	WAL-MART PHARMACY 10-3044	2900 RENAISSANCE SQUARE		FORT WORTH	TX	76105	01/01/2020	04/01/2022
CH062245B	WAL-MART PHARMACY 10-3044	2900 RENAISSANCE SQUARE		FORT WORTH	TX	76105	01/01/2020	04/01/2022
CH0622450	WAL-MART PHARMACY 10-3044	2900 RENAISSANCE SQUARE		FORT WORTH	TX	76105	01/01/2020	04/01/2022
CH0622450	WAL-MART PHARMACY 10-3135	717 WEST BERRY		FORT WORTH	TX	76110	01/01/2020	04/01/2022
CH062245B	WAL-MART PHARMACY 10-3135	717 WEST BERRY		FORT WORTH	TX	76110	01/01/2020	04/01/2022
CH062245C	WAL-MART PHARMACY 10-3135	717 WEST BERRY		FORT WORTH	TX	76110	01/01/2020	04/01/2022
CH062245C	WAL-MART PHARMACY 10-5312	3851 AIRPORT FREEWAY		FT WORTH	TX	76111	01/01/2020	04/01/2022
CH0622450	WAL-MART PHARMACY 10-5312	3851 AIRPORT FREEWAY		FT WORTH	TX	76111	01/01/2020	04/01/2022
CH062245B	WAL-MART PHARMACY 10-5312	3851 AIRPORT FREEWAY		FT WORTH	TX	76111	01/01/2020	04/01/2022
CH062245B	WAL-MART PHARMACY 10-5416	915 EAST RANDOL MILL ROAD		ARLINGTON(N)	TX	76011	01/01/2020	04/01/2022
CH0622450	WAL-MART PHARMACY 10-5416	915 EAST RANDOL MILL ROAD		ARLINGTON(N)	TX	76011	01/01/2020	04/01/2022
CH062245C	WAL-MART PHARMACY 10-5416	915 EAST RANDOL MILL ROAD		ARLINGTON(N)	TX	76011	01/01/2020	04/01/2022
CH062245C	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020	04/01/2022
CH0622450	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020	04/01/2022
CH062245B	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020	04/01/2022
CH0622450	WALGREEN CO.	DBA: WALGREENS # 05961	921 HENDERSON STREET	FT WORTH	TX	76102	04/29/2011
CH0622450	WALGREEN CO.	DBA: WALGREENS # 05922	108 NE 28TH ST	FT WORTH	TX	76164-7203	04/29/2011
CH0622450	WALGREEN CO.	DBA: WALGREENS # 04785	2400 JACKSBORO HWY	FT WORTH	TX	76114	05/02/2011	08/24/2017
CH0622450	WALGREEN CO.	DBA: WALGREENS # 09763	4515 CAMP BOWIE BLVD	FT WORTH	TX	76107-3836	04/29/2011
CH0622450	WALGREEN CO.	DBA: WALGREENS # 04268	3809 E. BELKNAP	FT WORTH	TX	76111	05/02/2011
CH0622450	WALGREEN CO.	DBA: WALGREENS # 04189	6244 LAKE WORTH BLVD.	LAKE WORTH	TX	76135	04/29/2011
CH0622450	WALGREEN CO.	DBA: WALGREENS # 05435	3100 MILLER AVE.	FT WORTH	TX	76105	04/29/2011	04/10/2024
CH0622450	WALGREEN CO.	DBA: WALGREENS # 02537	1020 N COLLINS ST	ARLINGTON	TX	76011-6134	01/01/2016
CH0622450	WALGREEN CO.	DBA: WALGREENS # 06996	4200 E LANCASTER AVE	FORT WORTH	TX	76103	07/01/2024
CH0622450	Walgreens #21373	Walgreens Central Fill #21373	4100 Dale Earnhardt Way STE 200	Northlake	TX	76262	07/01/2022
CH062245C	WALMART PHARMACY 10-4165	2245 JACKSBORO HIGHWAY		FORT WORTH	TX	76114	01/01/2020	04/01/2022
CH062245B	WALMART PHARMACY 10-4165	2245 JACKSBORO HIGHWAY		FORT WORTH	TX	76114	01/01/2020	04/01/2022
CH0622450	WALMART PHARMACY 10-4165	2245 JACKSBORO HIGHWAY		FORT WORTH	TX	76114	01/01/2020	04/01/2022

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 5:05:03 PM	2/24/2025 9:47:44 AM	2/24/2025 9:47 AM
Details	Last Recertification Date	Update	Recertification	1/30/2023 1:50:09 PM	1/30/2024 5:05:03 PM	1/30/2024 5:05 PM
Contacts	Primary Contact	Update	Change Request	PYRON, JERRY CFO North Texas Area Communith Health Center, Inc 8175466477	Willis, Susan Compliance Officer North Texas Area Community Health Center 8175466472	12/18/2023 5:28 PM
Details	Last Recertification Date	Update	Recertification	1/31/2022 9:40:36 AM	1/30/2023 1:50:09 PM	1/30/2023 1:50 PM
Details	Last Recertification Date	Update	Recertification	2/17/2021 11:10:31 AM	1/31/2022 9:40:36 AM	1/31/2022 9:40 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/17/2021 11:10 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		220596501	2/17/2021 11:10 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		TX	2/17/2021 11:10 AM
Medicaid Billing	NPI: State	Update	Recertification		TX	2/17/2021 11:10 AM
Details	Last Recertification Date	Update	Recertification	1/28/2020 1:24:45 PM	2/17/2021 11:10:31 AM	2/17/2021 11:10 AM
Details	Last Recertification Date	Update	Recertification	1/30/2019 9:24:27 AM	1/28/2020 1:24:45 PM	1/28/2020 1:24 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1700192085	2/13/2019 9:22 AM
Addresses	Billing Address	Update	Recertification	North Texas Area Community Health Centers, Inc. 2100 N. Main Street, Suite 110 Fort Worth, TX 76164-8572	North Texas Area Community Health Centers, Inc. 2332 Beverly Hills Drive Ft Worth, TX 76114-8572	1/30/2019 9:24 AM
Details	Last Recertification Date	Update	Recertification	2/23/2018 12:12:27 PM	1/30/2019 9:24:27 AM	1/30/2019 9:24 AM
Details	Last Recertification Date	Update	Recertification	2/8/2017 12:00:00 AM	2/23/2018 12:12:27 PM	2/23/2018 12:12 PM
Contacts	Authorizing Official	Update	AO Change Request	TREVINO, ELIZABETH CEO 8175466478	Whitaker, Gerrie CEO North Texas Area Community Health Centers, Inc. 8175466478	2/20/2018 10:34 AM
Contacts	Primary Contact	Update		PYRON, JERRY CFO 8175466477	PYRON, JERRY CFO North Texas Area Communith Health Center, Inc 8175466477	2/13/2018 11:22 AM
Addresses	Main Address	Insert			2909 Mitchell Blvd Fort Worth, TX 76105	2/8/2017 9:48 AM
Contacts	Authorizing Official	Insert			TREVINO, ELIZABETH CEO 8175466478	2/8/2017 9:48 AM
Contacts	Primary Contact	Update		Remor, Toni R. CFO 8175466477	PYRON, JERRY CFO 8175466477	2/8/2017 9:48 AM
Contacts	Signed By	Insert			Viveros, Arcadio CEO 8173780855	2/8/2017 9:48 AM
Details	Last Recertification Date	Update		2/22/2016 12:00:00 AM	2/8/2017 12:00:00 AM	2/8/2017 9:48 AM
Details	Last Recertification Date	Update		2/10/2015 12:00:00 AM	2/22/2016 12:00:00 AM	2/22/2016 3:35 PM
Addresses	Billing Address	Insert			North Texas Area Community Health Centers, Inc. 2100 N. Main Street, Suite 110 Fort Worth, TX 76164-8572	10/26/2015 7:41 AM
Details	Last Recertification Date	Update		3/17/2014 12:00:00 AM	2/10/2015 12:00:00 AM	2/10/2015 3:31 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/17/2014 12:00:00 AM	3/17/2014 7:40 AM
Details	Entity Name	Update		North Texas Area Community Health Centers, Inc.	NORTH TEXAS AREA COMMUNITY HEALTH CENTERS INC	3/17/2014 7:40 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/4/2013 9:33 AM
Contacts	Primary Contact	Insert			Remor, Toni R. CFO 8175466477	12/19/2011 5:13 PM
Dates	Participating Approval Date	Update			9/26/2011 12:00:00 AM	9/26/2011 6:06 PM
Details	State	Update		Pending	Active	9/26/2011 6:06 PM
Dates	Start Date	Update			10/1/2011 12:00:00 AM	9/26/2011 6:06 PM
Details	340B ID	Update		ONLINE_REG	CH062245B	9/8/2011 1:51 PM
Details	Last Recertification Date	Insert				7/26/2011 12:54 PM
Details	Grant Number	Insert			H80CS06457	7/26/2011 12:54 PM
Details	340B ID	Insert			ONLINE_REG	7/26/2011 12:54 PM
Details	Is Authorizing Official EHB Data	Insert				7/26/2011 12:54 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/26/2011 12:54 PM
Details	Medicare Provider Number	Insert				7/26/2011 12:54 PM
Details	Entity Name	Insert			North Texas Area Community Health Centers, Inc.	7/26/2011 12:54 PM
Details	Program Code	Insert			CH	7/26/2011 12:54 PM
Details	Entity Subname	Insert			Southeast Community Health Center	7/26/2011 12:54 PM
Dates	Participating Approval Date	Insert				7/26/2011 12:54 PM
Details	State	Insert			Pending	7/26/2011 12:54 PM
Dates	Registration Date	Insert			7/26/2011 12:00:00 AM	7/26/2011 12:54 PM
Dates	Signed By Date	Insert			7/26/2011 12:00:00 AM	7/26/2011 12:54 PM
Dates	Start Date	Insert				7/26/2011 12:54 PM
Terminations	Termination Comments	Insert				7/26/2011 12:54 PM
Terminations	Termination Date	Insert				7/26/2011 12:54 PM
Terminations	Termination Effective Date	Insert				7/26/2011 12:54 PM
Terminations	Termination Reason	Insert				7/26/2011 12:54 PM

340B Drug Pricing Program Database