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ANDERSON'S GIBSON PHARMACY
CHC26190-00 TYLER FAMILY CIRCLE OF CARE
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Covered Entity Details
Entity Name
TYLER FAMILY CIRCLE OF CARE
Subdivision Name
Tyler Family Circle of Care - Pediatric Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26190-00
Entity Address
214 E. Houston
Tyler, TX 75702-8131
Grant Number
H80CS26190
Participating Start Date
1/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
ANDERSON'S GIBSON PHARMACY
Pharmacy Address
600 S PALESTINE ST STE 100
ATHENS, TX 75751
Pharmacy Comments
Contract Details
Approval Date
7/13/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Erich Koch, Chief Financial Officer
(903) 525-7497
Contract Pharmacy Representative
Gibson Pharmacy
Lisa Kocian, Pharmacist
(903) 681-3868
Signed By Date
7/13/2018
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