Contract Pharmacy Details

ENCORE PHARMACY #1
CH05190A Heartland Alliance Health, INC.

Covered Entity Details

Entity Name

Heartland Alliance Health, INC.

Subdivision Name

Heartland Alliance Health James West Clinic

Type

HRSA-Funded Health Center

340B ID

CH05190A

Entity Address

932 W WASHINGTON BLVD
STE 224
Chicago, IL 60607-2217

Grant Number

H80CS00111

Participating Start Date

4/1/2014

Last Recertification Date

1/29/2024

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

ENCORE PHARMACY #1

Pharmacy Address

800 8TH AVE STE 130
FORT WORTH, TX 76104

Pharmacy Comments

Contract Details

Approval Date

5/3/2022

Contract Begin Date

5/4/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Ed Stellon, Executive Director
(773) 751-4109

Contract Pharmacy Representative

Encore Pharmacy
SANDRA VALDEZ, 340B Account Manager
(210) 788-9625

Signed By Date

5/3/2022

340B Drug Pricing Program Database