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RECEPT PHARMACY #1
CH05190A Heartland Alliance Health, INC.
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Covered Entity Details
Entity Name
Heartland Alliance Health, INC.
Subdivision Name
Heartland Alliance Health James West Clinic
Type
HRSA-Funded Health Center
340B ID
CH05190A
Entity Address
932 W WASHINGTON BLVD
STE 224
Chicago, IL 60607-2217
Grant Number
H80CS00111
Participating Start Date
4/1/2014
Last Recertification Date
1/29/2024
Entity Termination Date
1/1/2025
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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