Covered Entity Details

CHC24197-05 Health Services of North Texas, Inc. (Active) - information as of 5/14/2025 10:25:41 PM

Main Details

Name

Health Services of North Texas, Inc.

Subdivision Name

HSNT Wylie Children's Medical Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-014250

340B ID

CHC24197-05

Grant Number

H80CS24197

Additional Details

Current Program Status

Active

Registration Date

10/13/2017

Participating Start Date

1/1/2018

Participating Approval Date

10/17/2017

Last Recertification Date

2/23/2025

Contacts

Authorizing Official

Health Services of North Texas
Doreen Rue, CEO
(940) 381-1501 Ext: 3001

Primary Contact

Health Services of North Texas
Anna Contreras, Senior Practice Administrator
(940) 435-9044

Addresses

Street Address

303 S Highway 78
Ste 106
Wylie, TX 75098

Billing Address

Health Services of North Texas, Inc.
4401 N INTERSTATE 35
Unit 312
Denton, TX 76207-3318

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?
No

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	ASPCARES	13988 DIPLOMAT DR STE 100B		FARMERS BRANCH	TX	75234-8807	01/15/2018	04/01/2018	07/09/2020	07/13/2020
Contract Detail	CARIE BOYD PHARMACEUTICALS	2501 W OAK ST STE 100		DENTON	TX	76201	07/15/2020	10/01/2020	06/21/2021	06/25/2021
Contract Detail	RENUE RX #1	REMOTE SITE	306 N LOOP 288 STE 210	DENTON	TX	76209	07/15/2020	10/01/2020		10/01/2020
Contract Detail	RENUE RX #1	FRISCO APOTHECARY, LP	3010 LEGACY DR STE 110	FRISCO	TX	75034	01/12/2021	04/01/2021		04/01/2021
Contract Detail	RENUE RX #1	RENUE RX #2- TELP (REMOTE SITE)	5501 INDEPENDENCE PKWY STE 110-B	PLANO	TX	75023-5463	10/13/2021	01/01/2022		01/01/2022
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/15/2020	10/01/2020	12/31/2023	01/11/2024
Contract Detail	WAL-MART PHARMACY 10-0467	1515 SOUTH LOOP 288		DENTON	TX	76208	07/15/2020	10/01/2020	12/31/2023	01/11/2024
Contract Detail	WAL-MART PHARMACY 10-4627	2750 W UNIVERSITY DR		DENTON	TX	76201	07/15/2020	10/01/2020	06/03/2021	06/25/2021
Contract Detail	WAL-MART PHARMACY 10-5707	11700 US HWY 380		CROSS ROADS	TX	76227	07/15/2020	10/01/2020	04/17/2023	04/17/2023
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/15/2020	10/01/2020	12/31/2023	01/11/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11770	2300 E. PARK BLVD.	PLANO	TX	75074-5130	04/16/2018	07/01/2018		04/16/2018
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16538	7859 WALNUT HILL LN STE 110	DALLAS	TX	75230	04/16/2018	07/01/2018		04/16/2018
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16505	1050 W ROSEDALE ST STE 100	FORT WORTH	TX	76104	04/16/2018	07/01/2018		04/16/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05161	101 W UNIVERSITY	DENTON	TX	76201	04/16/2018	07/01/2018		04/16/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07542	1700 S LOOP 288	DENTON	TX	76205	04/16/2018	07/01/2018		04/16/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06759	4001 FM 2181	CORINTH	TX	76210	04/15/2020	07/01/2020		07/01/2020
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15318	3826 CEDAR SPRINGS RD	DALLAS	TX	75219	01/12/2021	04/01/2021		04/01/2021
Contract Detail	WALGREEN CO.	DBA WALGREENS #21173	1600 COIT RD. SUITE 108	PLANO	TX	75075-6171	04/13/2021	07/01/2021	06/29/2023	09/11/2023
Contract Detail	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	07/16/2018	10/01/2018		10/01/2018
Contract Detail	Walgreens MFC #21373	4100 Dale Earnhardt Way	200	Northlake	TX	76262	10/16/2023	01/01/2024		01/01/2024
Contract Detail	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	07/16/2018	10/01/2018		10/01/2018
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/17/2023	07/01/2023	12/31/2023	01/11/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC24197-01	Active	BPS-H80-012002	Health Services of North Texas, Inc.	HSNT Denton Medical Center 4308	4308 Mesa Dr	Denton	TX
CHC24197-02	Terminated	BPS-H80-011718	HEALTH SERVICES OF NORTH TEXAS , INC.	HSNT Medical Center	4310 Mesa Dr	Denton	TX
CHC24197-03	Active	BPS-H80-014155	Health Services of North Texas, Inc.	HSNT Denton South Center	3537 South I35E	Denton	TX
CHC24197-04	Terminated	BPS-H80-014248	Health Services of North Texas , Inc.	HSNT Plano Children's Medical Clinic	1407 14TH ST	PLANO	TX
CHC24197-05	Active	BPS-H80-014250	Health Services of North Texas, Inc.	HSNT Wylie Children's Medical Clinic	303 S Highway 78	Wylie	TX
CHC24197-06	Terminated	BPS-H80-014740	Health Services of North Texas , Inc.	HSNT- Elm Street Center	821 N Elm St	Denton	TX
CHC24197-07	Active	BPS-H80-016873	Health Services of North Texas, Inc.	HSNT Denton Medical Center 4304	4304 Mesa Drive	Denton	TX
CHC24197-08	Active	BPS-H80-032582	Health Services of North Texas , Inc.	HSNT Plano	5501 Independence Pkwy	Plano	TX
CHC24197-09	Active	BPS-H80-027689	Health Services of North Texas, Inc.	HSNT Serve Denton Center	306 N Loop 288	Denton	TX

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC24197-02	ASPCARES	2436 I-35 E SOUTH STE 360		DENTON	TX	76205	01/01/2015	04/01/2019
CHC24197-01	ASPCARES	2436 I-35 E SOUTH STE 360		DENTON	TX	76205	01/01/2015	07/09/2020
CHC24197-03	ASPCARES	2436 I-35 E SOUTH STE 360		DENTON	TX	76205	01/01/2015	07/09/2020
CHC24197-01	ASPCARES	13988 DIPLOMAT DR STE 100B		FARMERS BRANCH	TX	75234-8807	04/01/2018	07/09/2020
CHC24197-06	ASPCARES	13988 DIPLOMAT DR STE 100B		FARMERS BRANCH	TX	75234-8807	04/01/2018	07/01/2018
CHC24197-07	ASPCARES	13988 DIPLOMAT DR STE 100B		FARMERS BRANCH	TX	75234-8807	04/01/2018	07/09/2020
CHC24197-04	ASPCARES	13988 DIPLOMAT DR STE 100B		FARMERS BRANCH	TX	75234-8807	04/01/2018	04/01/2020
CHC24197-05	ASPCARES	13988 DIPLOMAT DR STE 100B		FARMERS BRANCH	TX	75234-8807	04/01/2018	07/09/2020
CHC24197-03	ASPCARES	13988 DIPLOMAT DR STE 100B		FARMERS BRANCH	TX	75234-8807	04/01/2018	07/09/2020
CHC24197-02	CARIE BOYD PHARMACEUTICALS	2501 W OAK ST STE 100		DENTON	TX	76201	10/01/2014	04/01/2019
CHC24197-01	CARIE BOYD PHARMACEUTICALS	2501 W OAK ST STE 100		DENTON	TX	76201	10/01/2014	07/13/2020
CHC24197-03	CARIE BOYD PHARMACEUTICALS	2501 W OAK ST STE 100		DENTON	TX	76201	01/01/2015	07/13/2020
CHC24197-08	CARIE BOYD PHARMACEUTICALS	2501 W OAK ST STE 100		DENTON	TX	76201	10/01/2020	06/21/2021
CHC24197-09	CARIE BOYD PHARMACEUTICALS	2501 W OAK ST STE 100		DENTON	TX	76201	10/01/2020	06/21/2021
CHC24197-07	CARIE BOYD PHARMACEUTICALS	2501 W OAK ST STE 100		DENTON	TX	76201	10/01/2020	06/21/2021
CHC24197-03	CARIE BOYD PHARMACEUTICALS	2501 W OAK ST STE 100		DENTON	TX	76201	10/01/2020	06/21/2021
CHC24197-01	CARIE BOYD PHARMACEUTICALS	2501 W OAK ST STE 100		DENTON	TX	76201	10/01/2020	06/21/2021
CHC24197-05	CARIE BOYD PHARMACEUTICALS	2501 W OAK ST STE 100		DENTON	TX	76201	10/01/2020	06/21/2021
CHC24197-07	CARIE BOYD PHARMACEUTICALS	2501 W OAK ST STE 100		DENTON	TX	76201	01/01/2022	10/13/2021
CHC24197-08	RENUE RX #1	REMOTE SITE	306 N LOOP 288 STE 210	DENTON	TX	76209	10/01/2020
CHC24197-09	RENUE RX #1	REMOTE SITE	306 N LOOP 288 STE 210	DENTON	TX	76209	10/01/2020
CHC24197-07	RENUE RX #1	REMOTE SITE	306 N LOOP 288 STE 210	DENTON	TX	76209	10/01/2020
CHC24197-03	RENUE RX #1	REMOTE SITE	306 N LOOP 288 STE 210	DENTON	TX	76209	10/01/2020
CHC24197-01	RENUE RX #1	REMOTE SITE	306 N LOOP 288 STE 210	DENTON	TX	76209	10/01/2020
CHC24197-05	RENUE RX #1	REMOTE SITE	306 N LOOP 288 STE 210	DENTON	TX	76209	10/01/2020
CHC24197-03	RENUE RX #1	FRISCO APOTHECARY, LP	3010 LEGACY DR STE 110	FRISCO	TX	75034	04/01/2021
CHC24197-05	RENUE RX #1	FRISCO APOTHECARY, LP	3010 LEGACY DR STE 110	FRISCO	TX	75034	04/01/2021
CHC24197-08	RENUE RX #1	FRISCO APOTHECARY, LP	3010 LEGACY DR STE 110	FRISCO	TX	75034	04/01/2021
CHC24197-01	RENUE RX #1	FRISCO APOTHECARY, LP	3010 LEGACY DR STE 110	FRISCO	TX	75034	04/01/2021
CHC24197-09	RENUE RX #1	FRISCO APOTHECARY, LP	3010 LEGACY DR STE 110	FRISCO	TX	75034	04/01/2021
CHC24197-07	RENUE RX #1	FRISCO APOTHECARY, LP	3010 LEGACY DR STE 110	FRISCO	TX	75034	04/01/2021
CHC24197-01	RENUE RX #1	RENUE RX #2- TELP (REMOTE SITE)	5501 INDEPENDENCE PKWY STE 110-B	PLANO	TX	75023-5463	01/01/2022
CHC24197-03	RENUE RX #1	RENUE RX #2- TELP (REMOTE SITE)	5501 INDEPENDENCE PKWY STE 110-B	PLANO	TX	75023-5463	01/01/2022
CHC24197-05	RENUE RX #1	RENUE RX #2- TELP (REMOTE SITE)	5501 INDEPENDENCE PKWY STE 110-B	PLANO	TX	75023-5463	01/01/2022
CHC24197-07	RENUE RX #1	RENUE RX #2- TELP (REMOTE SITE)	5501 INDEPENDENCE PKWY STE 110-B	PLANO	TX	75023-5463	01/01/2022
CHC24197-08	RENUE RX #1	RENUE RX #2- TELP (REMOTE SITE)	5501 INDEPENDENCE PKWY STE 110-B	PLANO	TX	75023-5463	01/01/2022
CHC24197-09	RENUE RX #1	RENUE RX #2- TELP (REMOTE SITE)	5501 INDEPENDENCE PKWY STE 110-B	PLANO	TX	75023-5463	01/01/2022
CHC24197-01	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2020	12/31/2023
CHC24197-09	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2020	12/31/2023
CHC24197-08	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2020	12/31/2023
CHC24197-07	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2020	12/31/2023
CHC24197-03	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2020	12/31/2023
CHC24197-05	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2020	12/31/2023
CHC24197-01	WAL-MART PHARMACY 10-0467	1515 SOUTH LOOP 288		DENTON	TX	76208	10/01/2020	12/31/2023
CHC24197-09	WAL-MART PHARMACY 10-0467	1515 SOUTH LOOP 288		DENTON	TX	76208	10/01/2020	12/31/2023
CHC24197-08	WAL-MART PHARMACY 10-0467	1515 SOUTH LOOP 288		DENTON	TX	76208	10/01/2020	12/31/2023
CHC24197-07	WAL-MART PHARMACY 10-0467	1515 SOUTH LOOP 288		DENTON	TX	76208	10/01/2020	12/31/2023
CHC24197-03	WAL-MART PHARMACY 10-0467	1515 SOUTH LOOP 288		DENTON	TX	76208	10/01/2020	12/31/2023
CHC24197-05	WAL-MART PHARMACY 10-0467	1515 SOUTH LOOP 288		DENTON	TX	76208	10/01/2020	12/31/2023
CHC24197-01	WAL-MART PHARMACY 10-4627	2750 W UNIVERSITY DR		DENTON	TX	76201	10/01/2020	06/03/2021
CHC24197-09	WAL-MART PHARMACY 10-4627	2750 W UNIVERSITY DR		DENTON	TX	76201	10/01/2020	06/03/2021
CHC24197-08	WAL-MART PHARMACY 10-4627	2750 W UNIVERSITY DR		DENTON	TX	76201	10/01/2020	06/03/2021
CHC24197-07	WAL-MART PHARMACY 10-4627	2750 W UNIVERSITY DR		DENTON	TX	76201	10/01/2020	06/03/2021
CHC24197-03	WAL-MART PHARMACY 10-4627	2750 W UNIVERSITY DR		DENTON	TX	76201	10/01/2020	06/03/2021
CHC24197-05	WAL-MART PHARMACY 10-4627	2750 W UNIVERSITY DR		DENTON	TX	76201	10/01/2020	06/03/2021
CHC24197-01	WAL-MART PHARMACY 10-5707	11700 US HWY 380		CROSS ROADS	TX	76227	10/01/2020	04/17/2023
CHC24197-09	WAL-MART PHARMACY 10-5707	11700 US HWY 380		CROSS ROADS	TX	76227	10/01/2020	04/17/2023
CHC24197-08	WAL-MART PHARMACY 10-5707	11700 US HWY 380		CROSS ROADS	TX	76227	10/01/2020	04/17/2023
CHC24197-07	WAL-MART PHARMACY 10-5707	11700 US HWY 380		CROSS ROADS	TX	76227	10/01/2020	04/17/2023
CHC24197-03	WAL-MART PHARMACY 10-5707	11700 US HWY 380		CROSS ROADS	TX	76227	10/01/2020	04/17/2023
CHC24197-05	WAL-MART PHARMACY 10-5707	11700 US HWY 380		CROSS ROADS	TX	76227	10/01/2020	04/17/2023
CHC24197-09	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2020	12/31/2023
CHC24197-01	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2020	12/31/2023
CHC24197-08	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2020	12/31/2023
CHC24197-07	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2020	12/31/2023
CHC24197-03	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2020	12/31/2023
CHC24197-05	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2020	12/31/2023
CHC24197-03	WALGREEN CO.	DBA: WALGREENS # 07542	1700 S LOOP 288	DENTON	TX	76205	07/01/2018
CHC24197-07	WALGREEN CO.	DBA: WALGREENS # 05161	101 W UNIVERSITY	DENTON	TX	76201	07/01/2018
CHC24197-03	WALGREEN CO.	DBA: WALGREENS #11770	2300 E. PARK BLVD.	PLANO	TX	75074-5130	07/01/2018
CHC24197-08	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16538	7859 WALNUT HILL LN STE 110	DALLAS	TX	75230	07/01/2018
CHC24197-08	WALGREEN CO.	DBA: WALGREENS # 07542	1700 S LOOP 288	DENTON	TX	76205	07/01/2018
CHC24197-05	WALGREEN CO.	DBA: WALGREENS #11770	2300 E. PARK BLVD.	PLANO	TX	75074-5130	07/01/2018
CHC24197-05	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16538	7859 WALNUT HILL LN STE 110	DALLAS	TX	75230	07/01/2018
CHC24197-07	WALGREEN CO.	DBA: WALGREENS # 07542	1700 S LOOP 288	DENTON	TX	76205	07/01/2018
CHC24197-04	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16538	7859 WALNUT HILL LN STE 110	DALLAS	TX	75230	07/01/2018	04/01/2020
CHC24197-05	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16505	1050 W ROSEDALE ST STE 100	FORT WORTH	TX	76104	07/01/2018
CHC24197-03	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16505	1050 W ROSEDALE ST STE 100	FORT WORTH	TX	76104	07/01/2018
CHC24197-03	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16538	7859 WALNUT HILL LN STE 110	DALLAS	TX	75230	07/01/2018
CHC24197-05	WALGREEN CO.	DBA: WALGREENS # 05161	101 W UNIVERSITY	DENTON	TX	76201	07/01/2018
CHC24197-08	WALGREEN CO.	DBA: WALGREENS # 05161	101 W UNIVERSITY	DENTON	TX	76201	07/01/2018
CHC24197-08	WALGREEN CO.	DBA: WALGREENS #11770	2300 E. PARK BLVD.	PLANO	TX	75074-5130	07/01/2018
CHC24197-04	WALGREEN CO.	DBA: WALGREENS # 05161	101 W UNIVERSITY	DENTON	TX	76201	07/01/2018	04/01/2020
CHC24197-03	WALGREEN CO.	DBA: WALGREENS # 05161	101 W UNIVERSITY	DENTON	TX	76201	07/01/2018
CHC24197-04	WALGREEN CO.	DBA: WALGREENS #11770	2300 E. PARK BLVD.	PLANO	TX	75074-5130	07/01/2018	04/01/2020
CHC24197-07	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16505	1050 W ROSEDALE ST STE 100	FORT WORTH	TX	76104	07/01/2018
CHC24197-04	WALGREEN CO.	DBA: WALGREENS # 07542	1700 S LOOP 288	DENTON	TX	76205	07/01/2018	04/01/2020
CHC24197-04	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16505	1050 W ROSEDALE ST STE 100	FORT WORTH	TX	76104	07/01/2018	04/01/2020
CHC24197-08	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16505	1050 W ROSEDALE ST STE 100	FORT WORTH	TX	76104	07/01/2018
CHC24197-05	WALGREEN CO.	DBA: WALGREENS # 07542	1700 S LOOP 288	DENTON	TX	76205	07/01/2018
CHC24197-07	WALGREEN CO.	DBA: WALGREENS #11770	2300 E. PARK BLVD.	PLANO	TX	75074-5130	07/01/2018
CHC24197-02	WALGREEN CO.	DBA: WALGREENS # 05161	101 W UNIVERSITY	DENTON	TX	76201	07/01/2018	04/01/2019
CHC24197-01	WALGREEN CO.	DBA: WALGREENS #11770	2300 E. PARK BLVD.	PLANO	TX	75074-5130	07/01/2018
CHC24197-02	WALGREEN CO.	DBA: WALGREENS #11770	2300 E. PARK BLVD.	PLANO	TX	75074-5130	07/01/2018	04/01/2019
CHC24197-01	WALGREEN CO.	DBA: WALGREENS # 05161	101 W UNIVERSITY	DENTON	TX	76201	07/01/2018
CHC24197-02	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16505	1050 W ROSEDALE ST STE 100	FORT WORTH	TX	76104	07/01/2018	04/01/2019
CHC24197-02	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16538	7859 WALNUT HILL LN STE 110	DALLAS	TX	75230	07/01/2018	04/01/2019
CHC24197-01	WALGREEN CO.	DBA: WALGREENS # 07542	1700 S LOOP 288	DENTON	TX	76205	07/01/2018
CHC24197-01	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16505	1050 W ROSEDALE ST STE 100	FORT WORTH	TX	76104	07/01/2018
CHC24197-02	WALGREEN CO.	DBA: WALGREENS # 07542	1700 S LOOP 288	DENTON	TX	76205	07/01/2018	04/01/2019
CHC24197-01	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16538	7859 WALNUT HILL LN STE 110	DALLAS	TX	75230	07/01/2018
CHC24197-07	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16538	7859 WALNUT HILL LN STE 110	DALLAS	TX	75230	07/01/2018
CHC24197-01	WALGREEN CO.	DBA: WALGREENS # 06759	4001 FM 2181	CORINTH	TX	76210	07/01/2020
CHC24197-03	WALGREEN CO.	DBA: WALGREENS # 06759	4001 FM 2181	CORINTH	TX	76210	07/01/2020
CHC24197-08	WALGREEN CO.	DBA: WALGREENS # 06759	4001 FM 2181	CORINTH	TX	76210	07/01/2020
CHC24197-07	WALGREEN CO.	DBA: WALGREENS # 06759	4001 FM 2181	CORINTH	TX	76210	07/01/2020
CHC24197-05	WALGREEN CO.	DBA: WALGREENS # 06759	4001 FM 2181	CORINTH	TX	76210	07/01/2020
CHC24197-09	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16505	1050 W ROSEDALE ST STE 100	FORT WORTH	TX	76104	10/01/2020
CHC24197-09	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16538	7859 WALNUT HILL LN STE 110	DALLAS	TX	75230	10/01/2020
CHC24197-09	WALGREEN CO.	DBA: WALGREENS # 05161	101 W UNIVERSITY	DENTON	TX	76201	10/01/2020
CHC24197-09	WALGREEN CO.	DBA: WALGREENS # 06759	4001 FM 2181	CORINTH	TX	76210	10/01/2020
CHC24197-09	WALGREEN CO.	DBA: WALGREENS #11770	2300 E. PARK BLVD.	PLANO	TX	75074-5130	10/01/2020
CHC24197-09	WALGREEN CO.	DBA: WALGREENS # 07542	1700 S LOOP 288	DENTON	TX	76205	10/01/2020
CHC24197-03	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15318	3826 CEDAR SPRINGS RD	DALLAS	TX	75219	04/01/2021
CHC24197-07	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15318	3826 CEDAR SPRINGS RD	DALLAS	TX	75219	04/01/2021
CHC24197-09	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15318	3826 CEDAR SPRINGS RD	DALLAS	TX	75219	04/01/2021
CHC24197-01	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15318	3826 CEDAR SPRINGS RD	DALLAS	TX	75219	04/01/2021
CHC24197-08	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15318	3826 CEDAR SPRINGS RD	DALLAS	TX	75219	04/01/2021
CHC24197-05	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15318	3826 CEDAR SPRINGS RD	DALLAS	TX	75219	04/01/2021
CHC24197-01	WALGREEN CO.	DBA WALGREENS #21173	1600 COIT RD. SUITE 108	PLANO	TX	75075-6171	07/01/2021	06/29/2023
CHC24197-03	WALGREEN CO.	DBA WALGREENS #21173	1600 COIT RD. SUITE 108	PLANO	TX	75075-6171	07/01/2021	06/29/2023
CHC24197-05	WALGREEN CO.	DBA WALGREENS #21173	1600 COIT RD. SUITE 108	PLANO	TX	75075-6171	07/01/2021	06/29/2023
CHC24197-07	WALGREEN CO.	DBA WALGREENS #21173	1600 COIT RD. SUITE 108	PLANO	TX	75075-6171	07/01/2021	06/29/2023
CHC24197-08	WALGREEN CO.	DBA WALGREENS #21173	1600 COIT RD. SUITE 108	PLANO	TX	75075-6171	07/01/2021	06/29/2023
CHC24197-09	WALGREEN CO.	DBA WALGREENS #21173	1600 COIT RD. SUITE 108	PLANO	TX	75075-6171	07/01/2021	06/29/2023
CHC24197-01	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	10/01/2018
CHC24197-02	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	10/01/2018	04/01/2019
CHC24197-03	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	10/01/2018
CHC24197-04	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	10/01/2018	04/01/2020
CHC24197-05	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	10/01/2018
CHC24197-07	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	10/01/2018
CHC24197-08	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	10/01/2018
CHC24197-09	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	10/01/2020
CHC24197-01	Walgreens MFC #21373	4100 Dale Earnhardt Way	200	Northlake	TX	76262	01/01/2024
CHC24197-03	Walgreens MFC #21373	4100 Dale Earnhardt Way	200	Northlake	TX	76262	01/01/2024
CHC24197-05	Walgreens MFC #21373	4100 Dale Earnhardt Way	200	Northlake	TX	76262	01/01/2024
CHC24197-07	Walgreens MFC #21373	4100 Dale Earnhardt Way	200	Northlake	TX	76262	01/01/2024
CHC24197-08	Walgreens MFC #21373	4100 Dale Earnhardt Way	200	Northlake	TX	76262	01/01/2024
CHC24197-09	Walgreens MFC #21373	4100 Dale Earnhardt Way	200	Northlake	TX	76262	01/01/2024
CHC24197-01	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	10/01/2018
CHC24197-02	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	10/01/2018	04/01/2019
CHC24197-03	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	10/01/2018
CHC24197-04	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	10/01/2018	04/01/2020
CHC24197-05	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	10/01/2018
CHC24197-07	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	10/01/2018
CHC24197-08	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	10/01/2018
CHC24197-09	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	10/01/2020
CHC24197-01	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023	12/31/2023
CHC24197-03	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023	12/31/2023
CHC24197-08	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023	12/31/2023
CHC24197-09	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023	12/31/2023
CHC24197-05	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023	12/31/2023
CHC24197-07	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023	12/31/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Billing Address	Update	Recertification	Health Services of North Texas 4401 N Interstate 35 Suite 312 Denton, TX 76207-3318	Health Services of North Texas, Inc. 4401 N INTERSTATE 35 Unit 312 Denton, TX 76207-3318	2/23/2025 1:00 PM
Details	Last Recertification Date	Update	Recertification	2/16/2024 6:55:36 PM	2/23/2025 1:00:35 PM	2/23/2025 1:00 PM
Details	Entity Name	Update	Recertification	Health Services of North Texas , Inc.	Health Services of North Texas, Inc.	2/23/2025 1:00 PM
Details	Last Recertification Date	Update	Recertification	2/23/2023 2:29:33 PM	2/16/2024 6:55:36 PM	2/16/2024 6:55 PM
Addresses	Main Address	Update	Change Request	303 S Highway 78 106 Wylie, TX 75098	303 S Highway 78 Ste 106 Wylie, TX 75098	7/20/2023 11:32 AM
Addresses	Billing Address	Update	Change Request	Health Services of North Texas 4401 N Interstate 35 312 Denton, TX 76207-3318	Health Services of North Texas 4401 N Interstate 35 Suite 312 Denton, TX 76207-3318	7/20/2023 11:32 AM
Addresses	Main Address	Update	Recertification	303 S. Hwy. 78, Suite 106 Wylie, TX 75098	303 S Highway 78 106 Wylie, TX 75098	2/23/2023 2:29 PM
Addresses	Billing Address	Update	Recertification	Health Services of North Texas 4401 N 1-35 Suite 312 Denton, TX 76207-3318	Health Services of North Texas 4401 N Interstate 35 312 Denton, TX 76207-3318	2/23/2023 2:29 PM
Details	Last Recertification Date	Update	Recertification	2/9/2022 11:36:20 PM	2/23/2023 2:29:33 PM	2/23/2023 2:29 PM
Details	Last Recertification Date	Update	Recertification	2/4/2021 3:13:38 PM	2/9/2022 11:36:20 PM	2/9/2022 11:36 PM
Details	Last Recertification Date	Update	Recertification	1/31/2020 10:51:42 AM	2/4/2021 3:13:38 PM	2/4/2021 3:13 PM
Details	Last Recertification Date	Update	Recertification	1/29/2019 10:34:14 AM	1/31/2020 10:51:42 AM	1/31/2020 10:51 AM
Details	Last Recertification Date	Update	Recertification	2/14/2018 11:13:53 AM	1/29/2019 10:34:14 AM	1/29/2019 10:34 AM
Details	Last Recertification Date	Update	Recertification		2/14/2018 11:13:53 AM	2/14/2018 11:13 AM
Details	State	Update		Approved	Active	1/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Rue, Doreen CEO Health Services of North Texas 9403811501-3001	10/17/2017 12:18 PM
Details	340B ID	Update	New Registration		CHC24197-05	10/17/2017 12:18 PM
Dates	Participating Approval Date	Update	New Registration		10/17/2017 12:18:20 PM	10/17/2017 12:18 PM
Details	State	Update	New Registration	Pending	Approved	10/17/2017 12:18 PM
Dates	Signed By Date	Update	New Registration		10/16/2017 1:47:38 PM	10/17/2017 12:18 PM
Dates	Start Date	Update	New Registration		1/1/2018 12:00:00 AM	10/17/2017 12:18 PM
Contacts	Primary Contact	Update	Profile Change Request	Contreras, Anna Medical Center Business Manager Health Services of North Texas 9403811501-511003	Contreras, Anna Senior Practice Administrator Health Services of North Texas 9404359044	10/13/2017 3:50 PM
Addresses	Main Address	Insert	New Registration		303 S. Hwy. 78, Suite 106 Wylie, TX 75098	10/13/2017 3:06 PM
Addresses	Billing Address	Insert	New Registration		Health Services of North Texas 4401 N 1-35 Suite 312 Denton, TX 76207-3318	10/13/2017 3:06 PM
Contacts	Primary Contact	Insert	New Registration		Contreras, Anna Medical Center Business Manager Health Services of North Texas 9403811501-511003	10/13/2017 3:06 PM
Contacts	Authorizing Official	Insert	New Registration		Rue, Doreen CEO Health Services of North Texas 9403811501-3001	10/13/2017 3:06 PM
Details	Last Recertification Date	Insert	New Registration			10/13/2017 3:06 PM
Details	Grant Number	Insert	New Registration		H80CS24197	10/13/2017 3:06 PM
Details	340B ID	Insert	New Registration			10/13/2017 3:06 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/13/2017 3:06 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/13/2017 3:06 PM
Details	Medicare Provider Number	Insert	New Registration			10/13/2017 3:06 PM
Details	Entity Name	Insert	New Registration		Health Services of North Texas , Inc.	10/13/2017 3:06 PM
Details	Program Code	Insert	New Registration		CH	10/13/2017 3:06 PM
Details	Entity Subname	Insert	New Registration		HSNT Wylie Children's Medical Clinic	10/13/2017 3:06 PM
Dates	Participating Approval Date	Insert	New Registration			10/13/2017 3:06 PM
Details	State	Insert	New Registration		Pending	10/13/2017 3:06 PM
Dates	Registration Date	Insert	New Registration		10/13/2017 3:06:59 PM	10/13/2017 3:06 PM
Dates	Signed By Date	Insert	New Registration			10/13/2017 3:06 PM
Dates	Start Date	Insert	New Registration			10/13/2017 3:06 PM
Terminations	Termination Comments	Insert	New Registration			10/13/2017 3:06 PM
Terminations	Termination Date	Insert	New Registration			10/13/2017 3:06 PM
Terminations	Termination Effective Date	Insert	New Registration			10/13/2017 3:06 PM
Terminations	Termination Reason	Insert	New Registration			10/13/2017 3:06 PM

340B Drug Pricing Program Database