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WAL-MART PHARMACY 10-5707
CHC24197-01 Health Services of North Texas, Inc.
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Covered Entity Details
Entity Name
Health Services of North Texas, Inc.
Subdivision Name
HSNT Denton Medical Center 4308
Type
HRSA-Funded Health Center
340B ID
CHC24197-01
Entity Address
4308 Mesa Dr
Denton, TX 76207-3459
Grant Number
H80CS24197
Participating Start Date
10/1/2014
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5707
Pharmacy Address
11700 US HWY 380
CROSS ROADS, TX 76227
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/17/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Doreen Rue, CEO
(940) 381-1501 Ext: 3001
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/13/2020
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