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EAST SIDE PHARMACY
CHC26190-00 TYLER FAMILY CIRCLE OF CARE
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Covered Entity Details
Entity Name
TYLER FAMILY CIRCLE OF CARE
Subdivision Name
Tyler Family Circle of Care - Pediatric Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26190-00
Entity Address
214 E. Houston
Tyler, TX 75702-8131
Grant Number
H80CS26190
Participating Start Date
1/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
EAST SIDE PHARMACY
Pharmacy Address
1109 E 5TH ST
TYLER, TX 75701
Pharmacy Comments
Contract Details
Approval Date
9/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristen S Harris, CEO
(903) 606-6637
Contract Pharmacy Representative
East Side Pharmacy
Daniel Hayek, Managing officer
(903) 354-0231
Signed By Date
9/12/2024
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