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Walgreens #21373
CHC07502-00 Legacy Community Health Services, Inc.
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Covered Entity Details
Entity Name
Legacy Community Health Services, Inc.
Subdivision Name
Legacy Montrose Clinic
Type
HRSA-Funded Health Center
340B ID
CHC07502-00
Entity Address
1415 California St
Houston, TX 77006-2602
Grant Number
H80CS07502
Participating Start Date
10/1/2004
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
Walgreens #21373
Pharmacy Address
Walgreens Central Fill #21373
4100 Dale Earnhardt Way
STE 200
Northlake, TX 76262
Pharmacy Comments
Contract Details
Approval Date
10/1/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Katy Caldwell, Executive Director
(832) 548-5050
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/1/2021
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