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WALGREEN CO.
DSH450039 Tarrant County Hospital District d/b/a JPS Health Network
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Covered Entity Details
Entity Name
Tarrant County Hospital District d/b/a JPS Health Network
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450039
Entity Address
1500 S Main Street
FORT WORTH, TX 76104
Medicare Provider Number
450039
Participating Start Date
8/1/1993
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05092
3418 MCKINNEY AVE
DALLAS, TX 75204
Pharmacy Comments
Contract Details
Approval Date
1/16/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joy Parker, SVP, Operations
(817) 702-5802 Ext: 8177027143
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/16/2025
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