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CVS PHARMACY, INC.
STD75235 Resource Center of Dallas
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Covered Entity Details
Entity Name
Resource Center of Dallas
Subdivision Name
Nelson-Tebedo Clinic
Type
Sexually Transmitted Diseases
340B ID
STD75235
Entity Address
2603 Inwood
Dallas, TX 75235
Grant Number
NH25PS005182
Participating Start Date
4/1/2017
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA CVS/PHARMACY #10634
2350 N. FITZHUGH AVENUE
DALLAS, TX 75204
Pharmacy Comments
Contract Details
Approval Date
10/3/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marisa Elliott, Chief Operating Officer
(214) 540-4454
Contract Pharmacy Representative
CVS Health
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
10/3/2022
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