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WAL-MART PHARMACY 10-0467
CHC24197-05 Health Services of North Texas, Inc.
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Covered Entity Details
Entity Name
Health Services of North Texas, Inc.
Subdivision Name
HSNT Wylie Children's Medical Clinic
Type
HRSA-Funded Health Center
340B ID
CHC24197-05
Entity Address
303 S Highway 78
Ste 106
Wylie, TX 75098
Grant Number
H80CS24197
Participating Start Date
1/1/2018
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0467
Pharmacy Address
1515 SOUTH LOOP 288
DENTON, TX 76208
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2023
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
7/15/2020
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