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RECEPT PHARMACY #1
CH05190B Heartland Alliance Health, Inc.
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Covered Entity Details
Entity Name
Heartland Alliance Health, Inc.
Subdivision Name
HEARTLAND ALLIANCE HEALTH - ENGLEWOOD
Type
HRSA-Funded Health Center
340B ID
CH05190B
Entity Address
5501 S HALSTED ST
CHICAGO, IL 60621-2229
Grant Number
H80CS00111
Participating Start Date
7/1/2018
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
4/16/2018
Contract Begin Date
7/1/2018
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
4/16/2018
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