Covered Entity Details

CH061010 MARTIN LUTHER KING JR FAMILY CLINIC INC (Active) - information as of 6/21/2025 12:05:20 AM

Main Details

Name

MARTIN LUTHER KING JR FAMILY CLINIC INC

Subdivision Name

MARTIN LUTHER KING, JR. FAMILY CLINIC, INC. dba Foremost Family Health Centers

Type

HRSA-Funded Health Center

Site ID

BPS-H80-001291

340B ID

CH061010

Grant Number

H80CS00127

Additional Details

Current Program Status

Active

Registration Date

12/1/1992

Participating Start Date

12/1/1992

Participating Approval Date

12/1/1992

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Martin Luther King, Jr. Family Clinic
JOYCE E. TAPLEY, CEO
(469) 601-9360

Primary Contact

Martin Luther King Jr. Family Clinic
Herron Mitchell, Chief Operations Officer
(469) 451-8740

Addresses

Street Address

2922B Martin Luther King Jr Blvd
Dallas, TX 75215

Billing Address
Same as Street Address

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	FQ0000150

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	10/13/2023	01/01/2024		01/01/2024
Contract Detail	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	10/13/2023	01/01/2024		01/01/2024
Contract Detail	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	10/13/2023	01/01/2024		01/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03957	5101 S LANCASTER RD	DALLAS	TX	75241	04/21/2014	07/01/2014		04/21/2014
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04203	438 W. ILLINOIS AVE.	DALLAS	TX	75224	04/21/2014	07/01/2014		04/21/2014
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04624	1461 ROBERT B CULLUM BLVD	DALLAS	TX	75210	04/21/2014	07/01/2014		04/21/2014
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04705	2060 SOUTH BUCKNER BLVD.	DALLAS	TX	75217	04/21/2014	07/01/2014		04/21/2014
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04747	3211 S LANCASTER RD	DALLAS	TX	75216	04/21/2014	07/01/2014	04/03/2024	04/15/2024
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15318	3826 CEDAR SPRINGS RD	DALLAS	TX	75219	10/10/2017	01/01/2018		10/10/2017
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16538	7859 WALNUT HILL LN STE 110	DALLAS	TX	75230	10/10/2017	01/01/2018		10/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05959	1520 PIONEER RD	MESQUITE	TX	75149	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11645	10152 LAKE JUNE RD.	DALLAS	TX	75217	04/12/2022	07/01/2022		07/01/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09015	4702 N JIM MILLER RD	DALLAS	TX	75227-2801	04/15/2024	07/01/2024		07/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03822	401 N GALLOWAY AVE	MESQUITE	TX	75149	04/15/2024	07/01/2024		07/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS #09323	610 E. MALLOY BRIDGE RD.	SEAGOVILLE	TX	75159-1818	04/15/2024	07/01/2024		07/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06390	1015 N TOWN EAST BLVD	MESQUITE	TX	75150	07/09/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06197	2401 W LEDBETTER DR	DALLAS	TX	75233	07/09/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07334	5001 ROSS AVE	DALLAS	TX	75206-7706	07/09/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #21375	3910 GASTON AVE STE 125	DALLAS	TX	75246	04/14/2025	07/01/2025		04/14/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04459	8120 S. COCKRELL HILL ROAD	DALLAS	TX	75236	04/14/2025	07/01/2025		04/14/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07586	5950 BROADWAY BLVD.	GARLAND	TX	75043-5822	04/14/2025	07/01/2025		04/14/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07783	2301 LAKELAND DRIVE	DALLAS	TX	75228-5353	04/14/2025	07/01/2025		04/14/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05920	1060 WEST CAMP WISDOM RD	DALLAS	TX	75232	04/14/2025	07/01/2025		04/14/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05162	8310 ABRAMS RD	DALLAS	TX	75243	04/14/2025	07/01/2025		04/14/2025
Contract Detail	Walgreens #21373	Walgreens Central Fill #21373	4100 Dale Earnhardt Way STE 200	Northlake	TX	76262	04/12/2022	07/01/2022		07/01/2022
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/21/2014	07/01/2014	07/20/2015	08/04/2015

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH061010	Active	BPS-H80-001291	MARTIN LUTHER KING JR FAMILY CLINIC INC	MARTIN LUTHER KING, JR. FAMILY CLINIC, INC. dba Foremost Family Health Centers	2922B Martin Luther King Jr Blvd	Dallas	TX
CH06101A	Active	BPS-H80-012939	MARTIN LUTHER KING JR FAMILY CLINIC INC	Foremost Family Health Center - Balch Springs	3515 Shepherd Ln	Balch Springs	TX
CH06101B	Active	BPS-H80-034181	Martin Luther King Jr Family Clinic Inc	Foremost Family Health Centers - A+ Academy Elementary	10327 Rylie Rd Ofc # 4	Dallas	TX

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH061010	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	01/01/2024
CH06101A	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	01/01/2024
CH061010	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	01/01/2024
CH06101A	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	01/01/2024
CH061010	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	01/01/2024
CH06101A	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	01/01/2024
CH061010	WALGREEN CO.	DBA: WALGREENS # 03957	5101 S LANCASTER RD	DALLAS	TX	75241	07/01/2014
CH061010	WALGREEN CO.	DBA: WALGREENS # 04203	438 W. ILLINOIS AVE.	DALLAS	TX	75224	07/01/2014
CH061010	WALGREEN CO.	DBA: WALGREENS # 04624	1461 ROBERT B CULLUM BLVD	DALLAS	TX	75210	07/01/2014
CH061010	WALGREEN CO.	DBA: WALGREENS # 04705	2060 SOUTH BUCKNER BLVD.	DALLAS	TX	75217	07/01/2014
CH061010	WALGREEN CO.	DBA: WALGREENS # 04747	3211 S LANCASTER RD	DALLAS	TX	75216	07/01/2014	04/03/2024
CH061010	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15318	3826 CEDAR SPRINGS RD	DALLAS	TX	75219	01/01/2018
CH06101A	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15318	3826 CEDAR SPRINGS RD	DALLAS	TX	75219	01/01/2018
CH061010	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16538	7859 WALNUT HILL LN STE 110	DALLAS	TX	75230	01/01/2018
CH06101A	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16538	7859 WALNUT HILL LN STE 110	DALLAS	TX	75230	01/01/2018
CH06101A	WALGREEN CO.	DBA: WALGREENS #11645	10152 LAKE JUNE RD.	DALLAS	TX	75217	07/01/2018
CH061010	WALGREEN CO.	DBA: WALGREENS # 05959	1520 PIONEER RD	MESQUITE	TX	75149	01/01/2021
CH061010	WALGREEN CO.	DBA: WALGREENS #11645	10152 LAKE JUNE RD.	DALLAS	TX	75217	07/01/2022
CH061010	WALGREEN CO.	DBA: WALGREENS # 09015	4702 N JIM MILLER RD	DALLAS	TX	75227-2801	07/01/2024
CH061010	WALGREEN CO.	DBA: WALGREENS # 03822	401 N GALLOWAY AVE	MESQUITE	TX	75149	07/01/2024
CH061010	WALGREEN CO.	DBA: WALGREENS #09323	610 E. MALLOY BRIDGE RD.	SEAGOVILLE	TX	75159-1818	07/01/2024
CH061010	WALGREEN CO.	DBA: WALGREENS # 06390	1015 N TOWN EAST BLVD	MESQUITE	TX	75150	10/01/2024
CH061010	WALGREEN CO.	DBA: WALGREENS # 06197	2401 W LEDBETTER DR	DALLAS	TX	75233	10/01/2024
CH061010	WALGREEN CO.	DBA: WALGREENS # 07334	5001 ROSS AVE	DALLAS	TX	75206-7706	10/01/2024
CH061010	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #21375	3910 GASTON AVE STE 125	DALLAS	TX	75246	07/01/2025
CH061010	WALGREEN CO.	DBA: WALGREENS # 04459	8120 S. COCKRELL HILL ROAD	DALLAS	TX	75236	07/01/2025
CH061010	WALGREEN CO.	DBA: WALGREENS # 07586	5950 BROADWAY BLVD.	GARLAND	TX	75043-5822	07/01/2025
CH061010	WALGREEN CO.	DBA: WALGREENS # 07783	2301 LAKELAND DRIVE	DALLAS	TX	75228-5353	07/01/2025
CH061010	WALGREEN CO.	DBA: WALGREENS # 05920	1060 WEST CAMP WISDOM RD	DALLAS	TX	75232	07/01/2025
CH061010	WALGREEN CO.	DBA: WALGREENS # 05162	8310 ABRAMS RD	DALLAS	TX	75243	07/01/2025
CH061010	Walgreens #21373	Walgreens Central Fill #21373	4100 Dale Earnhardt Way STE 200	Northlake	TX	76262	07/01/2022
CH061010	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2014	07/20/2015

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 8:33:47 AM	2/10/2025 11:52:15 AM	2/10/2025 11:52 AM
Contacts	Primary Contact	Update	Recertification	Allen, Jolie Chief Operations Officer Foremost Family Health Center 2144263645-7066	Mitchell, Herron Chief Operations Officer Martin Luther King Jr. Family Clinic 4694518740	1/29/2024 8:33 AM
Details	Last Recertification Date	Update	Recertification	1/31/2023 11:18:59 AM	1/29/2024 8:33:47 AM	1/29/2024 8:33 AM
Details	Last Recertification Date	Update	Recertification	2/1/2022 9:02:05 AM	1/31/2023 11:18:59 AM	1/31/2023 11:18 AM
Contacts	Primary Contact	Update	Profile Change Request	Allen, Jolie Chief Operations Officer Foremost Family Health Center 2144462018-7066	Allen, Jolie Chief Operations Officer Foremost Family Health Center 2144263645-7066	7/1/2022 1:10 PM
Details	Last Recertification Date	Update	Recertification	2/8/2021 3:39:00 PM	2/1/2022 9:02:05 AM	2/1/2022 9:02 AM
Details	Last Recertification Date	Update	Recertification	1/28/2020 12:21:58 PM	2/8/2021 3:39:00 PM	2/8/2021 3:39 PM
Contacts	Authorizing Official	Update	Profile Change Request	TAPLEY, JOYCE E. CEO Martin Luther King, Jr. Family Clinic 2144263645-7056	TAPLEY, JOYCE E. CEO Martin Luther King, Jr. Family Clinic 4696019360	10/14/2020 11:10 AM
Contacts	Primary Contact	Update	Change Request	Brown, Steven Gary Chief Financial Officer Martin Luther King Jr Family Health Center 2144263645-7049	Allen, Jolie Chief Operations Officer Foremost Family Health Center 2144462018-7066	2/3/2020 5:24 PM
Details	Entity Subname	Update	Change Request	MARTIN LUTHER KING, JR. FAMILY CLINIC, INC.	MARTIN LUTHER KING, JR. FAMILY CLINIC, INC. dba Foremost Family Health Centers	2/3/2020 5:24 PM
Details	Last Recertification Date	Update	Recertification	1/30/2019 11:47:30 AM	1/28/2020 12:21:58 PM	1/28/2020 12:21 PM
Details	Last Recertification Date	Update	Recertification	2/22/2018 1:11:06 PM	1/30/2019 11:47:30 AM	1/30/2019 11:47 AM
Contacts	Primary Contact	Update	Profile Change Request	Brown, Steven Gary Chief Financial Officer Martin Kuther King Jr Family Health Center 2144263645-7049	Brown, Steven Gary Chief Financial Officer Martin Luther King Jr Family Health Center 2144263645-7049	2/22/2018 2:23 PM
Contacts	Primary Contact	Update	Recertification	TAPLEY, JOYCE E. CEO Martin Luther King, Jr. Family Clinic 2144263645-7056	Brown, Steven Gary Chief Financial Officer Martin Kuther King Jr Family Health Center 2144263645-7049	2/22/2018 1:11 PM
Details	Last Recertification Date	Update	Recertification	1/25/2017 12:00:00 AM	2/22/2018 1:11:06 PM	2/22/2018 1:11 PM
Contacts	Authorizing Official	Update		TAPLEY, JOYCE E. CEO 2144263645-7056	TAPLEY, JOYCE E. CEO Martin Luther King, Jr. Family Clinic 2144263645-7056	10/5/2017 1:17 PM
Contacts	Primary Contact	Update		TAPLEY, JOYCE E. CEO 2144263645-7056	TAPLEY, JOYCE E. CEO Martin Luther King, Jr. Family Clinic 2144263645-7056	10/5/2017 1:17 PM
Addresses	Main Address	Insert			2922B Martin Luther King Jr Blvd Dallas, TX 75215	2/8/2017 11:33 AM
Contacts	Authorizing Official	Update		TAPLEY, JOYCE E. CEO 2144263645-155	TAPLEY, JOYCE E. CEO 2144263645-7056	2/8/2017 11:33 AM
Contacts	Primary Contact	Update		Freeman, Marcus Chief Finance Officer 2144263645-151	TAPLEY, JOYCE E. CEO 2144263645-7056	2/8/2017 11:33 AM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	2/8/2017 11:33 AM
Details	Last Recertification Date	Update		2/22/2016 12:00:00 AM	1/25/2017 12:00:00 AM	2/8/2017 11:33 AM
Details	Last Recertification Date	Update		2/3/2015 12:00:00 AM	2/22/2016 12:00:00 AM	2/22/2016 12:30 PM
Contacts	Primary Contact	Update		Mehta, Jayshree CFO 2144263645-151	Freeman, Marcus Chief Finance Officer 2144263645-151	2/3/2015 1:35 PM
Details	Last Recertification Date	Update		3/17/2014 12:00:00 AM	2/3/2015 12:00:00 AM	2/3/2015 1:35 PM
Contacts	Primary Contact	Update		Nguyen, Erin CMO 2144263645-174	Mehta, Jayshree CFO 2144263645-151	4/30/2014 10:39 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/17/2014 12:00:00 AM	3/17/2014 7:32 AM
Details	Entity Name	Update		MARTIN LUTHER KING, JR. FAMILY CLINIC, INC.	MARTIN LUTHER KING JR FAMILY CLINIC INC	3/17/2014 7:32 AM
Details	Entity Subname	Update			MARTIN LUTHER KING, JR. FAMILY CLINIC, INC.	3/17/2014 7:32 AM
Contacts	Primary Contact	Insert			Nguyen, Erin CMO 2144263645-174	2/14/2013 3:02 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/14/2013 3:02 PM
Contacts	Authorizing Official	Insert			TAPLEY, JOYCE E. CEO 2144263645-155	8/25/2005 7:32 AM
Details	Last Recertification Date	Insert				8/25/2005 7:32 AM
Details	Grant Number	Insert			H80CS00127	8/25/2005 7:32 AM
Details	340B ID	Insert			CH061010	8/25/2005 7:32 AM
Details	Is Authorizing Official EHB Data	Insert				8/25/2005 7:32 AM
Dates	Last Date That 340B Drugs Purchased	Insert				8/25/2005 7:32 AM
Details	Medicare Provider Number	Insert				8/25/2005 7:32 AM
Details	Entity Name	Insert			MARTIN LUTHER KING, JR. FAMILY CLINIC, INC.	8/25/2005 7:32 AM
Details	Program Code	Insert			CH	8/25/2005 7:32 AM
Details	Entity Subname	Insert				8/25/2005 7:32 AM
Dates	Participating Approval Date	Insert			12/1/1992 12:00:00 AM	8/25/2005 7:32 AM
Details	State	Insert			Active	8/25/2005 7:32 AM
Dates	Registration Date	Insert			12/1/1992 12:00:00 AM	8/25/2005 7:32 AM
Dates	Signed By Date	Insert				8/25/2005 7:32 AM
Dates	Start Date	Insert			12/1/1992 12:00:00 AM	8/25/2005 7:32 AM
Terminations	Termination Comments	Insert				8/25/2005 7:32 AM
Terminations	Termination Date	Insert				8/25/2005 7:32 AM
Terminations	Termination Effective Date	Insert				8/25/2005 7:32 AM
Terminations	Termination Reason	Insert				8/25/2005 7:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	12/1/1992 12:00 AM
Medicaid Billing	Medicaid: Number	Insert			FQ0000150	12/1/1992 12:00 AM
Medicaid Billing	Medicaid: State	Insert			TX	12/1/1992 12:00 AM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

Grantee Sites

Grantee Sites Contract Pharmacies

History