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MALAKOFF PRESCRIPTION SHOP INC
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
MALAKOFF PRESCRIPTION SHOP INC
Pharmacy Address
DBA MALAKOFF PHARMACY
409 W ROYALL BLVD
P.O. BOX 1069
MALAKOFF, TX 75148
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
Gibson Pharmacy
Lisa Kocian, Pharmacist
(903) 681-3868
Signed By Date
9/12/2024
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