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WALGREEN CO.
DSH450039 Tarrant County Hospital District d/b/a JPS Health Network
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Covered Entity Details
Entity Name
Tarrant County Hospital District d/b/a JPS Health Network
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450039
Entity Address
1500 S Main Street
FORT WORTH, TX 76104
Medicare Provider Number
450039
Participating Start Date
8/1/1993
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03886
4202 S CARRIER PKWY
GRAND PRAIRIE, TX 75052
Pharmacy Comments
Contract Details
Approval Date
10/11/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen Scott Duncan, President, CEO JPS Health Network
(817) 702-2318
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2021
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