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V-CARE PHARMACY
CAH451319-00 MOTHER FRANCES HOSPITAL-JACKSONVILLE
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Covered Entity Details
Entity Name
MOTHER FRANCES HOSPITAL-JACKSONVILLE
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451319-00
Entity Address
2026 S.JACKSON ST.
JACKSONVILLE, TX 75766
Medicare Provider Number
451319
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
V-CARE PHARMACY
Pharmacy Address
AN&U INC
1729 S JACKSON ST
JACKSONVILLE, TX 75766
Pharmacy Comments
Contract Details
Approval Date
7/5/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anne Pileggi, Associate Vice President/Administrator
(903) 541-4515
Contract Pharmacy Representative
V-Care Pharmacy
Ravish N. Shah, Pharmacist
(903) 284-6256
Signed By Date
7/5/2018
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