Contract Pharmacy Details

NW-ACP
FQHCLA348 COLLIN COUNTY ADULT CLINIC

Covered Entity Details

Entity Name

COLLIN COUNTY ADULT CLINIC

Subdivision Name

Collin County Adult Clinic

Type

Health Center Program Look-Alike

340B ID

FQHCLA348

Entity Address

2520 K Ave STE 100
Plano, TX 75074-5342

Grant Number

LALCS00156

Participating Start Date

7/1/2017

Last Recertification Date

3/6/2018

Entity Termination Date

4/1/2019

Pharmacy Details

Pharmacy Name

NW-ACP

Pharmacy Address

800 PEAKWOOD DR, STE 4A
HOUSTON, TX 77090

Pharmacy Comments

Contract Details

Approval Date

4/17/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Patricia Sumler, Executive Director
(972) 423-4944

Contract Pharmacy Representative

Coty Leal, Manager
(936) 537-4698

Signed By Date

4/17/2017