Contract Pharmacy Details

Walgreens #21373
CHC33661-00 Good Shepherd Community Clinic, Inc.

Covered Entity Details

Entity Name

Good Shepherd Community Clinic, Inc.

Subdivision Name

Good Shepherd Community Clinic, Inc.

Type

HRSA-Funded Health Center

340B ID

CHC33661-00

Entity Address

20 12th Avenue NW
Ardmore, OK 73401-5722

Grant Number

H80CS33661

Participating Start Date

1/1/2020

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

Walgreens #21373

Pharmacy Address

Walgreens Central Fill #21373
4100 Dale Earnhardt Way
STE 200
Northlake, TX 76262

Pharmacy Comments

Contract Details

Approval Date

9/1/2022

Contract Begin Date

9/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Teresa Mae Myers, CEO
(580) 465-3545

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

9/1/2022

340B Drug Pricing Program Database