340B Drug Pricing Program Database

Pharmacy Name

RECEPT PHARMACY #15

Pharmacy Address

7148 TRAIL LAKE DRIVE, SUITE A
FORT WORTH, TX 76123

Pharmacy Comments

Approval Date

10/11/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

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