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RECEPT PHARMACY #15
RWII76104 TARRANT COUNTY PUBLIC HEALTH
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Covered Entity Details
Entity Name
TARRANT COUNTY PUBLIC HEALTH
Subdivision Name
PREVENTIVE MEDICINE CLINIC
Type
Ryan White Part B
340B ID
RWII76104
Entity Address
1101 SOUTH MAIN STREET, SUITE 1500C
FORT WORTH, TX 76104
Grant Number
XO7HA00054
Participating Start Date
7/1/2004
Last Recertification Date
2/23/2024
Entity Termination Date
7/1/2024
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
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
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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