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WALGREEN CO.
CH061010 MARTIN LUTHER KING JR FAMILY CLINIC INC
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Covered Entity Details
Entity Name
MARTIN LUTHER KING JR FAMILY CLINIC INC
Subdivision Name
MARTIN LUTHER KING, JR. FAMILY CLINIC, INC. dba Foremost Family Health Centers
Type
HRSA-Funded Health Center
340B ID
CH061010
Entity Address
2922B Martin Luther King Jr Blvd
Dallas, TX 75215
Grant Number
H80CS00127
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05959
1520 PIONEER RD
MESQUITE, TX 75149
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JOYCE E. TAPLEY, CEO
(469) 601-9360
Contract Pharmacy Representative
Walgreens
Edwin Raff, DVP Contracting & Pricing
(847) 964-6198
Signed By Date
10/14/2020
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