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WALGREEN CO.
CHC24197-02 HEALTH SERVICES OF NORTH TEXAS , INC.
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Covered Entity Details
Entity Name
HEALTH SERVICES OF NORTH TEXAS , INC.
Subdivision Name
HSNT Medical Center
Type
HRSA-Funded Health Center
340B ID
CHC24197-02
Entity Address
4310 Mesa Dr
Denton, TX 76207-3460
Grant Number
H80CS24197
Participating Start Date
10/1/2014
Last Recertification Date
2/16/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16538
7859 WALNUT HILL LN STE 110
DALLAS, TX 75230
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
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Debra Layman, Chief Operating Officer
(940) 381-1501 Ext: 533020
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2018
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