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WALGREEN CO.
CH06101A MARTIN LUTHER KING JR FAMILY CLINIC INC
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Covered Entity Details
Entity Name
MARTIN LUTHER KING JR FAMILY CLINIC INC
Subdivision Name
Foremost Family Health Center - Balch Springs
Type
HRSA-Funded Health Center
340B ID
CH06101A
Entity Address
3515 Shepherd Ln
Balch Springs, TX 75180-2325
Grant Number
H80CS00127
Participating Start Date
1/1/2015
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11645
10152 LAKE JUNE RD.
DALLAS, TX 75217
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JOYCE E. TAPLEY, CEO
(469) 601-9360
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2018
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