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RECEPT PHARMACY #1
CH051900 Heartland Alliance Health
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Covered Entity Details
Entity Name
Heartland Alliance Health
Subdivision Name
Heartland Alliance Health - Uptown
Type
HRSA-Funded Health Center
340B ID
CH051900
Entity Address
4009 N Broadway St
Chicago, IL 60613-2110
Grant Number
H80CS00111
Participating Start Date
1/1/2001
Last Recertification Date
1/29/2024
Pharmacy Details
Pharmacy Name
RECEPT PHARMACY #1
Pharmacy Address
800 8TH AVE STE 130
FORT WORTH, TX 76104
Pharmacy Comments
Contract Details
Approval Date
10/12/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/3/2022
Ownership change
Contacts
Covered Entity Signing Official
Ed Stellon, Executive Director
(773) 751-4109
Contract Pharmacy Representative
ReceptRX
Clay Keene, Vice President, Client Services
(914) 705-9046
Signed By Date
10/12/2017
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