Contract Pharmacy Details

RECEPT PHARMACY #1
CH0610680 INNIS COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

INNIS COMMUNITY HEALTH CENTER, INC.

Subdivision Name

INNIS COMMUNITY HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH0610680

Entity Address

6450 LA HIGHWAY 1 STE B
INNIS, LA 70747-0889

Grant Number

H80CS00855

Participating Start Date

1/1/2004

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

RECEPT PHARMACY #1

Pharmacy Address

800 8TH AVE STE 130
FORT WORTH, TX 76104

Pharmacy Comments

Contract Details

Approval Date

10/14/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/2/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

cindy peavy, Executive Director
(225) 235-9627

Contract Pharmacy Representative

Recept Pharmacy
Samantha Burford, Director of 340B Client Services
(817) 602-2332

Signed By Date

10/14/2021

340B Drug Pricing Program Database