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RECEPT PHARMACY #5
RWI76104 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 A
340B ID
RWI76104
Entity Address
1101 SOUTH MAIN STREET, SUITE 1500C
FORT WORTH, TX 76104
Grant Number
H89HA00047
Participating Start Date
7/1/2004
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
RECEPT PHARMACY #5
Pharmacy Address
1469 WEST STATE HIGHWAY 114
SUITE 598
GRAPEVINE, TX 76051
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/13/2019
Agreement registered in error
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
10/16/2017
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