Covered Entity Details

CHC28363-10 SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED (Terminated) - information as of 6/21/2025 10:45:34 PM

Main Details

Name

SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED

Subdivision Name

Women&s Health Tyler

Type

HRSA-Funded Health Center

Site ID

BPS-H80-022017

340B ID

CHC28363-10

Grant Number

H80CS28363

Additional Details

Current Program Status

Terminated

Registration Date

1/10/2019

Participating Start Date

4/1/2019

Participating Approval Date

1/22/2019

Last Recertification Date

Termination Date
Termination Reason

4/1/2020
Site closure

Contacts

Authorizing Official

Special Health Resources for Texas,INC.
David Wayne Hayes, CEO
(903) 212-7807

Primary Contact

Special Health Resources for Texas, Inc
Dionne Kittrell, Clinical Services Director
(903) 212-7811

Addresses

Street Address

825 Medical Drive
Tyler, TX 75701-2143

Billing Address

Special Health Resources for Texas, Inc
PO Box 2709
Longview, TX 75606

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	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC28363-00	Active	BPS-H80-039356	SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED	Longview Care Clinic	409 N. 6th Street	LONGVIEW	TX
CHC28363-01	Terminated	BPS-H80-017328	SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED	Texarkana Care Clinic (6th St)	300 East 6th St.	Texarkana	AR
CHC28363-02	Active	BPS-H80-015127	SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED	Texarkana Clinic	1102 Main St	Texarkana	TX
CHC28363-03	Active	BPS-H80-015123	SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED	Tyler Care Clinic (Midtown)	1300 Clinic Dr	Tyler	TX
CHC28363-04	Terminated	BPS-H80-015112	SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED	Med Plaza	703 E MARSHALL AVE	LONGVIEW	TX
CHC28363-05	Active	BPS-H80-018046	SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED	402 N. 7th St	402 N 7th St	Longview	TX
CHC28363-06	Terminated	BPS-H80-022295	SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED	Jacksonville Care Clinic	1011 College Street	Jacksonville	TX
CHC28363-07	Terminated	BPS-H80-022287	SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED	Suite 3000, Med Plaza III	705 E Marshall Ave Ste 3000	Longview	TX
CHC28363-08	Active	BPS-H80-018732	SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED	Paris Clinic	3150 Clarksville St.	Paris	TX
CHC28363-09	Active	BPS-H80-021522	SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED	Tyler Care Clinic	4519 Troup Hwy, Tyler, TX 75703	Tyler	TX
CHC28363-10	Terminated	BPS-H80-022017	SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED	Women&s Health Tyler	825 Medical Drive	Tyler	TX
CHC28363-11	Active	BPS-H80-021807	SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED	Integrated Care Clinic	1300 North 6th Street	Longview	TX
CHC28363-12	Active	BPS-H80-027801	SPECIAL HEALTH RESOURCES FOR TEXAS INC	INTUNE Mobile Clinic	410 N 4TH ST	LONGVIEW	TX

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC28363-00	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2023
CHC28363-00	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2023	10/14/2024
CHC28363-00	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2023	10/14/2024
CHC28363-00	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/01/2023
CHC28363-00	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2023
CHC28363-00	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2023	10/14/2024
CHC28363-00	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2023	10/14/2024
CHC28363-03	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/01/2023	01/01/2025
CHC28363-00	ACCREDO HEALTH GROUP, INC.		PHARMACY 2 BOULDEN CIRCLE SUITE 1	NEW CASTLE	DE	19720	07/01/2023	04/17/2023
CHC28363-00	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2025
CHC28363-00	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	10/01/2017	07/12/2024
CHC28363-00	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2018	07/12/2024
CHC28363-00	ARKANSAS CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10019	3908 N. STATELINE AVE.	TEXARKANA	AR	71854	07/01/2025
CHC28363-00	ASPCARES	AMERICAN SPECIALTY PHARMACY, INC	1109 E 5TH ST	TYLER	TX	75701-3318	07/01/2016	11/30/2022
CHC28363-00	ASPCARES	1219 BARRANCA DR.	STE. A	EL PASO	TX	79935	01/01/2017	11/30/2022
CHC28363-02	ASPCARES	AMERICAN SPECIALTY PHARMACY, INC	1109 E 5TH ST	TYLER	TX	75701-3318	07/01/2016	11/30/2022
CHC28363-02	ASPCARES	1219 BARRANCA DR.	STE. A	EL PASO	TX	79935	01/01/2017	11/30/2022
CHC28363-01	ASPCARES	AMERICAN SPECIALTY PHARMACY, INC	1109 E 5TH ST	TYLER	TX	75701-3318	01/01/2017	11/30/2022
CHC28363-01	ASPCARES	1219 BARRANCA DR.	STE. A	EL PASO	TX	79935	01/01/2017	11/30/2022
CHC28363-03	ASPCARES	AMERICAN SPECIALTY PHARMACY, INC	1109 E 5TH ST	TYLER	TX	75701-3318	07/01/2016	09/30/2022
CHC28363-03	ASPCARES	1219 BARRANCA DR.	STE. A	EL PASO	TX	79935	01/01/2017	11/30/2022
CHC28363-04	ASPCARES	AMERICAN SPECIALTY PHARMACY, INC	1109 E 5TH ST	TYLER	TX	75701-3318	07/01/2016	11/30/2022
CHC28363-04	ASPCARES	1219 BARRANCA DR.	STE. A	EL PASO	TX	79935	01/01/2017	11/30/2022
CHC28363-05	ASPCARES	1219 BARRANCA DR.	STE. A	EL PASO	TX	79935	01/01/2017	11/30/2022
CHC28363-05	ASPCARES	AMERICAN SPECIALTY PHARMACY, INC	1109 E 5TH ST	TYLER	TX	75701-3318	01/01/2017	11/30/2022
CHC28363-09	ASPCARES	AMERICAN SPECIALTY PHARMACY, INC	1109 E 5TH ST	TYLER	TX	75701-3318	07/01/2019	11/30/2022
CHC28363-00	AVELLA OF COLUMBUS	4830 KNIGHTSBRIDGE BLVD STE C		COLUMBUS	OH	43214-2300	10/01/2017	01/01/2025
CHC28363-00	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	10/01/2017	01/01/2025
CHC28363-00	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2025
CHC28363-00	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2025
CHC28363-00	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2025
CHC28363-00	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2025
CHC28363-00	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2025
CHC28363-00	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2025
CHC28363-00	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2025
CHC28363-00	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2025
CHC28363-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2025
CHC28363-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2025
CHC28363-03	CEDRA PHARMACY	9669 N CENTRAL EXPY STE 190		DALLAS	TX	75231-5056	10/01/2018	07/12/2024
CHC28363-00	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2025
CHC28363-00	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2025
CHC28363-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06944	3710 LAMAR AVE	PARIS	TX	75462	07/01/2025
CHC28363-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06899	1754 W LOOP 281	LONGVIEW	TX	75604	07/01/2025
CHC28363-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07293	400 E END BLVD NORTH	MARSHALL	TX	75670	07/01/2025
CHC28363-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06925	1000 STONE RD	KILGORE	TX	75662	07/01/2025
CHC28363-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06851	119 W MARSHALL AVE	LONGVIEW	TX	75601	07/01/2025	05/06/2025
CHC28363-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07444	1402 EAST BROADWAY	GLADEWATER	TX	75647	07/01/2025
CHC28363-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07490	507 CLARKSVILLE ST.	PARIS	TX	75460	07/01/2025
CHC28363-00	CVS PHARMACY, INC.	CVS/PHARMACY # 11152	1909 WEST BROADWAY ST	CLARKSVILLE	TX	75426	07/01/2025
CHC28363-00	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2025
CHC28363-00	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2023	10/14/2024
CHC28363-00	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2023	10/14/2024
CHC28363-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2023	10/14/2024
CHC28363-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2023	10/14/2024
CHC28363-00	GENOA HEALTHCARE LLC	1300 N 6TH ST STE B		LONGVIEW	TX	75601	07/01/2023
CHC28363-00	GENOA HEALTHCARE LLC	12234 SHADOW CREEK PKWY	BLDG 4, STE 104	PEARLAND	TX	77584	07/01/2023	04/29/2024
CHC28363-00	GENOA HEALTHCARE LLC	8535 TOM SLICK, STE 104		SAN ANTONIO	TX	78229	07/01/2023
CHC28363-00	KROGER PHARMACY #957	1310 CLARKSVILLE ROAD		PARIS	TX	75460	07/01/2023
CHC28363-00	KROGER PHARMACY #959	701 W MARSHALL		LONGVIEW	TX	75601	08/05/2024
CHC28363-00	LOUIS MORGAN DRUGS #1	HERVEY & BETHARD INC	1900 S HIGH ST	LONGVIEW	TX	75602	07/01/2019
CHC28363-05	LOUIS MORGAN DRUGS #1	HERVEY & BETHARD INC	1900 S HIGH ST	LONGVIEW	TX	75602	10/01/2024
CHC28363-11	MEDICAL PLAZA PHARMACY	615 N 3RD ST STE 1		LONGVIEW	TX	75601	07/01/2019
CHC28363-00	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	07/01/2023
CHC28363-00	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2025
CHC28363-00	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/01/2023
CHC28363-00	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	07/01/2023	04/29/2024
CHC28363-00	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	10/01/2024	10/01/2024
CHC28363-00	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/01/2023
CHC28363-08	PARIS APOTHECARY	PARIS APOTHECARY, LLC	707 LAMAR AVE STE B	PARIS	TX	75460-4460	04/01/2019	07/12/2024
CHC28363-00	PARIS APOTHECARY	PARIS APOTHECARY, LLC	707 LAMAR AVE STE B	PARIS	TX	75460-4460	10/01/2019	07/12/2024
CHC28363-00	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2018	07/12/2024
CHC28363-00	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2025
CHC28363-00	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2025
CHC28363-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2025
CHC28363-00	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4315 TEXAS BLVD	TEXARKANA	TX	75503	01/01/2017
CHC28363-02	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4315 TEXAS BLVD	TEXARKANA	TX	75503	01/01/2017
CHC28363-01	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4315 TEXAS BLVD	TEXARKANA	TX	75503	01/01/2017	04/01/2025
CHC28363-03	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4315 TEXAS BLVD	TEXARKANA	TX	75503	01/01/2017
CHC28363-04	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4315 TEXAS BLVD	TEXARKANA	TX	75503	01/01/2017	04/01/2024
CHC28363-05	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4315 TEXAS BLVD	TEXARKANA	TX	75503	01/01/2017
CHC28363-06	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4315 TEXAS BLVD	TEXARKANA	TX	75503	07/01/2019	01/01/2025
CHC28363-08	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4315 TEXAS BLVD	TEXARKANA	TX	75503	07/01/2019
CHC28363-09	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4315 TEXAS BLVD	TEXARKANA	TX	75503	07/01/2019
CHC28363-11	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4315 TEXAS BLVD	TEXARKANA	TX	75503	07/01/2019
CHC28363-09	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4503 TROUP HWY	TYLER	TX	75703	06/06/2023
CHC28363-01	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4503 TROUP HWY	TYLER	TX	75703	06/06/2023	04/01/2025
CHC28363-02	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4503 TROUP HWY	TYLER	TX	75703	06/06/2023
CHC28363-03	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4503 TROUP HWY	TYLER	TX	75703	06/06/2023
CHC28363-04	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4503 TROUP HWY	TYLER	TX	75703	06/06/2023	04/01/2024
CHC28363-05	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4503 TROUP HWY	TYLER	TX	75703	06/06/2023
CHC28363-06	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4503 TROUP HWY	TYLER	TX	75703	06/06/2023	01/01/2025
CHC28363-08	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4503 TROUP HWY	TYLER	TX	75703	06/06/2023
CHC28363-11	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4503 TROUP HWY	TYLER	TX	75703	06/06/2023
CHC28363-12	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4503 TROUP HWY	TYLER	TX	75703	06/06/2023
CHC28363-00	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4503 TROUP HWY	TYLER	TX	75703	06/06/2023
CHC28363-00	RELIANT MEDICAL LLC DBA RELIANT HEALTHCA	1004 N 19TH ST		MONROE	LA	71201-5734	01/01/2017
CHC28363-02	RELIANT MEDICAL LLC DBA RELIANT HEALTHCA	1004 N 19TH ST		MONROE	LA	71201-5734	01/01/2017
CHC28363-01	RELIANT MEDICAL LLC DBA RELIANT HEALTHCA	1004 N 19TH ST		MONROE	LA	71201-5734	01/01/2017	04/01/2025
CHC28363-03	RELIANT MEDICAL LLC DBA RELIANT HEALTHCA	1004 N 19TH ST		MONROE	LA	71201-5734	01/01/2017
CHC28363-04	RELIANT MEDICAL LLC DBA RELIANT HEALTHCA	1004 N 19TH ST		MONROE	LA	71201-5734	01/01/2017	04/01/2024
CHC28363-05	RELIANT MEDICAL LLC DBA RELIANT HEALTHCA	1004 N 19TH ST		MONROE	LA	71201-5734	01/01/2017
CHC28363-06	RELIANT MEDICAL LLC DBA RELIANT HEALTHCA	1004 N 19TH ST		MONROE	LA	71201-5734	07/01/2019	01/01/2025
CHC28363-09	RELIANT MEDICAL LLC DBA RELIANT HEALTHCA	1004 N 19TH ST		MONROE	LA	71201-5734	07/01/2019
CHC28363-11	RELIANT MEDICAL LLC DBA RELIANT HEALTHCA	1004 N 19TH ST		MONROE	LA	71201-5734	07/01/2019
CHC28363-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2023
CHC28363-00	WAL-MART PHARMACY 10-0038	1907 SE WASHINGTON STREET		IDABEL	OK	74745	07/01/2023	03/25/2024
CHC28363-00	WAL-MART PHARMACY 10-0131	2311 S. JEFFERSON		MOUNT PLEASANT	TX	75455	07/01/2023	03/25/2024
CHC28363-00	WAL-MART PHARMACY 10-0148	3855 LAMAR AVENUE		PARIS	TX	75460	07/01/2023
CHC28363-00	WAL-MART PHARMACY 10-0180	1311 S. JACKSON		JACKSONVILLE	TX	75766	07/01/2023
CHC28363-00	WAL-MART PHARMACY 10-0181	800 JAMES BOWIE DRIVE		NEW BOSTON	TX	75570	07/01/2023
CHC28363-00	WAL-MART PHARMACY 10-0345	2223 SOUTH LOOP 256		PALESTINE	TX	75801	07/01/2023	03/25/2024
CHC28363-00	WAL-MART PHARMACY 10-0399	2440 GILMER RD		LONGVIEW	TX	75604	07/01/2023
CHC28363-00	WAL-MART PHARMACY 10-0572	1201 STONE RD		KILGORE	TX	75662	07/01/2023	05/15/2025
CHC28363-00	WAL-MART PHARMACY 10-1022	3820 HIGHWAY 64 WEST		TYLER	TX	75704	07/01/2023	03/25/2024
CHC28363-00	WAL-MART PHARMACY 10-4193	1900 EAST SE LOOP 323		TYLER	TX	75703	07/01/2023
CHC28363-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2023
CHC28363-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2024
CHC28363-00	WALMART PHARMACY 10-6467	450 S SOUTHEAST LOOP 323		TYLER	TX	75702-7570	07/01/2023	05/15/2025
CHC28363-00	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2020 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		3/7/2019 12:00:00 AM	2/24/2020 8:29 AM
Details	State	Update	Recertification	Active	To Be Terminated	2/24/2020 8:29 AM
Terminations	Termination Comments	Update	Recertification		Pending Change in scope approval for termination of site.	2/24/2020 8:29 AM
Terminations	Termination Date	Update	Recertification		4/1/2020 12:00:00 AM	2/24/2020 8:29 AM
Terminations	Termination Effective Date	Update	Recertification		4/1/2020 12:00:00 AM	2/24/2020 8:29 AM
Terminations	Termination Reason	Update	Recertification		Site closure	2/24/2020 8:29 AM
Contacts	Authorizing Official	Update	AO Change Request	Nesvig, Kim CEO Special Health Resources for Texas, Inc. 9032127811-7811	Hayes, David Wayne CEO Special Health Resources for Texas,INC. 9032127807	2/11/2020 3:14 PM
Details	State	Update		Approved	Active	4/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Nesvig, Kim CEO Special Health Resources for Texas, Inc. 9032127811-7811	1/22/2019 2:30 PM
Details	340B ID	Update	New Registration		CHC28363-10	1/22/2019 2:30 PM
Dates	Participating Approval Date	Update	New Registration		1/22/2019 2:30:09 PM	1/22/2019 2:30 PM
Details	State	Update	New Registration	Pending	Approved	1/22/2019 2:30 PM
Dates	Signed By Date	Update	New Registration		1/10/2019 11:25:14 AM	1/22/2019 2:30 PM
Dates	Start Date	Update	New Registration		4/1/2019 12:00:00 AM	1/22/2019 2:30 PM
Addresses	Main Address	Insert	New Registration		825 Medical Drive Tyler, TX 75701-2143	1/10/2019 11:25 AM
Addresses	Billing Address	Insert	New Registration		Special Health Resources for Texas, Inc PO Box 2709 Longview, TX 75606	1/10/2019 11:25 AM
Contacts	Authorizing Official	Insert	New Registration		Nesvig, Kim CEO Special Health Resources for Texas, Inc. 9032127811-7811	1/10/2019 11:25 AM
Contacts	Primary Contact	Insert	New Registration		Kittrell, Dionne Clinical Services Director Special Health Resources for Texas, Inc 9032127811	1/10/2019 11:25 AM
Details	Last Recertification Date	Insert	New Registration			1/10/2019 11:25 AM
Details	Grant Number	Insert	New Registration		H80CS28363	1/10/2019 11:25 AM
Details	340B ID	Insert	New Registration			1/10/2019 11:25 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/10/2019 11:25 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/10/2019 11:25 AM
Details	Medicare Provider Number	Insert	New Registration			1/10/2019 11:25 AM
Details	Entity Name	Insert	New Registration		SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED	1/10/2019 11:25 AM
Details	Program Code	Insert	New Registration		CH	1/10/2019 11:25 AM
Details	Entity Subname	Insert	New Registration		Women&s Health Tyler	1/10/2019 11:25 AM
Dates	Participating Approval Date	Insert	New Registration			1/10/2019 11:25 AM
Details	State	Insert	New Registration		Pending	1/10/2019 11:25 AM
Dates	Registration Date	Insert	New Registration		1/10/2019 11:25:13 AM	1/10/2019 11:25 AM
Dates	Signed By Date	Insert	New Registration			1/10/2019 11:25 AM
Dates	Start Date	Insert	New Registration			1/10/2019 11:25 AM
Terminations	Termination Comments	Insert	New Registration			1/10/2019 11:25 AM
Terminations	Termination Date	Insert	New Registration			1/10/2019 11:25 AM
Terminations	Termination Effective Date	Insert	New Registration			1/10/2019 11:25 AM
Terminations	Termination Reason	Insert	New Registration			1/10/2019 11:25 AM

340B Drug Pricing Program Database