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KROGER PHARMACY #509
RWII75219 Resource Center of Dallas
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Covered Entity Details
Entity Name
Resource Center of Dallas
Subdivision Name
Type
Ryan White Part B
340B ID
RWII75219
Entity Address
2701 Reagan Street
Dallas, TX 75219
Grant Number
X07HA00054
Participating Start Date
7/1/2015
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #509
Pharmacy Address
4901 MAPLE AVE
DALLAS, TX 75235
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
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