Contract Pharmacy Details

HEB PHARMACY #583
SCH450348-00 FALLS COMMUNITY HOSPITAL AND CLINIC

Covered Entity Details

Entity Name

FALLS COMMUNITY HOSPITAL AND CLINIC

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH450348-00

Entity Address

322 COLEMAN
MARLIN, TX 76661

Medicare Provider Number

450348

Participating Start Date

1/1/2017

Last Recertification Date

9/15/2021

Entity Termination Date

10/1/2022

Pharmacy Details

Pharmacy Name

HEB PHARMACY #583

Pharmacy Address

9100 WOODWAY DRIVE
WOODWAY, TX 76712

Pharmacy Comments

Contract Details

Approval Date

7/10/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/10/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

John Graham, Administrator
(254) 803-3561 Ext: 2101

Contract Pharmacy Representative

HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578

Signed By Date

7/10/2018

340B Drug Pricing Program Database