Contract Pharmacy Details

KROGER PHARMACY #528
RWI75219 Resource Center of Dallas

Covered Entity Details

Entity Name

Resource Center of Dallas

Subdivision Name

Type

Ryan White Part A

340B ID

RWI75219

Entity Address

2701 Reagan Street
Dallas, TX 75219

Grant Number

H89HA00002

Participating Start Date

7/1/2015

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

KROGER PHARMACY #528

Pharmacy Address

4142 CEDAR SPRINGS
DALLAS, TX 75219

Pharmacy Comments

Contract Details

Approval Date

4/13/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/21/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Marisa Elliott, Chief Operating Officer
(214) 540-4454

Contract Pharmacy Representative

Kroger
Katie Elfers, 340B Pharmacy Administrator
(513) 762-4850

Signed By Date

4/13/2022

340B Drug Pricing Program Database