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ADVANCECARE DALLAS
STD891041 Community Outreach Medical Center
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Covered Entity Details
Entity Name
Community Outreach Medical Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD891041
Entity Address
2080 E. Flamingo Rd.
Suite 302
Las Vegas, NV 89119-2803
Grant Number
1NH25PS005179-01-00
Participating Start Date
7/1/2019
Last Recertification Date
5/6/2025
Pharmacy Details
Pharmacy Name
ADVANCECARE DALLAS
Pharmacy Address
3818 CEDAR SPRINGS RD STE 104
DALLAS, TX 75219
Pharmacy Comments
Contract Details
Approval Date
10/7/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
kema ogden, Executive Director
(702) 604-6052
Contract Pharmacy Representative
AdvanceCare Pharmacy
Kyle Bernier, Director of Operations
(508) 971-8380
Signed By Date
10/7/2024
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