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RECEPT PHARMACY #15
STD76014 Tarrant County Public Health
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Covered Entity Details
Entity Name
Tarrant County Public Health
Subdivision Name
STD Division
Type
Sexually Transmitted Diseases
340B ID
STD76014
Entity Address
2596 E. Arkansas
Arlington, TX 76014
Grant Number
NH25PS005182
Participating Start Date
10/1/2017
Last Recertification Date
5/13/2024
Pharmacy Details
Pharmacy Name
RECEPT PHARMACY #15
Pharmacy Address
7148 TRAIL LAKE DRIVE, SUITE A
FORT WORTH, TX 76123
Pharmacy Comments
Contract Details
Approval Date
10/11/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Salyer-Caldwell, Deputy Director
(817) 321-5309
Contract Pharmacy Representative
ReceptRX
Clay Keene, Vice President, Client Services
(914) 705-9046
Signed By Date
10/11/2017
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