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WALGREEN CO.
CH0622450 NORTH TEXAS AREA COMMUNITY HEALTH CENTERS INC
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Covered Entity Details
Entity Name
NORTH TEXAS AREA COMMUNITY HEALTH CENTERS INC
Subdivision Name
North Texas Area Community Health Centers, Inc.
Type
HRSA-Funded Health Center
340B ID
CH0622450
Entity Address
2332 Beverly Hills Drive
Fort Worth, TX 76114
Grant Number
H80CS06457
Participating Start Date
11/18/2005
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05922
108 NE 28TH ST
FT WORTH, TX 76164-7203
Pharmacy Comments
01/15/2014 - Pharmacy name/address correction, changed in error on 3/28/2013.
Contract Details
Approval Date
4/5/2011
Contract Begin Date
4/29/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
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