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Walgreens MFC #21373
CHC24197-05 Health Services of North Texas, Inc.
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Covered Entity Details
Entity Name
Health Services of North Texas, Inc.
Subdivision Name
HSNT Wylie Children's Medical Clinic
Type
HRSA-Funded Health Center
340B ID
CHC24197-05
Entity Address
303 S Highway 78
Ste 106
Wylie, TX 75098
Grant Number
H80CS24197
Participating Start Date
1/1/2018
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
Walgreens MFC #21373
Pharmacy Address
4100 Dale Earnhardt Way
200
Northlake, TX 76262
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Doreen Rue, CEO
(940) 381-1501 Ext: 3001
Contract Pharmacy Representative
Walgreens
Tony Joe Chriscoe, 340 Client Relations Analyst
(847) 315-5806
Signed By Date
10/16/2023
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