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WALGREEN CO.
CHC24154-00 MISSION EAST DALLAS
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Covered Entity Details
Entity Name
MISSION EAST DALLAS
Subdivision Name
Mission East Dallas and MetroPlex Project
Type
HRSA-Funded Health Center
340B ID
CHC24154-00
Entity Address
4550 Gus Thomasson Road
Suite 40
Mesquite, TX 75150
Grant Number
H80CS24154
Participating Start Date
4/1/2014
Last Recertification Date
2/2/2023
Entity Termination Date
10/1/2023
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06120
9937 GARLAND ROAD
DALLAS, TX 75218
Pharmacy Comments
Contract Details
Approval Date
7/17/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Charles Joseph Wiltraught, Executive Director
(972) 682-8917 Ext: 112
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2014
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