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SUPER 1 PHARMACY #615
CH060820 Community Health Service Agency, Inc. Of Hunt County, The
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Covered Entity Details
Entity Name
Community Health Service Agency, Inc. Of Hunt County, The
Subdivision Name
Carevide
Type
HRSA-Funded Health Center
340B ID
CH060820
Entity Address
4500 Wesley St
Greenville, TX 75401-5644
Grant Number
H80CS00675
Participating Start Date
12/1/1992
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
SUPER 1 PHARMACY #615
Pharmacy Address
4811 WESLEY STREET
GREENVILLE, TX 75401
Pharmacy Comments
Contract Details
Approval Date
7/6/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/15/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michelle Carter, Chief Executive Officer
(903) 455-5986
Contract Pharmacy Representative
Brookshire Grocery Company
Neil Ducote, Director of Pharmacy
(903) 600-1376
Signed By Date
7/6/2022
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