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WAL-MART PHARMACY 10-3135
CH062245B NORTH TEXAS AREA COMMUNITY HEALTH CENTERS INC
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Covered Entity Details
Entity Name
NORTH TEXAS AREA COMMUNITY HEALTH CENTERS INC
Subdivision Name
Southeast Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH062245B
Entity Address
2909 Mitchell Blvd
Fort Worth, TX 76105
Grant Number
H80CS06457
Participating Start Date
10/1/2011
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3135
Pharmacy Address
717 WEST BERRY
FORT WORTH, TX 76110
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gerrie Whitaker, CEO
(817) 546-6478
Contract Pharmacy Representative
North Texas Area Communith Health Center, Inc
JERRY PYRON, CFO
(817) 546-6477
Signed By Date
10/15/2019
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