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GODS COUNTRY PHARMACY
CAH451330-00 MEDINA COUNTY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
MEDINA COUNTY HOSPITAL DISTRICT
Subdivision Name
MEDINA REGIONAL HOSPITAL
Type
Critical Access Hospital
340B ID
CAH451330-00
Entity Address
3100 AVENUE E
HONDO, TX 78861
Medicare Provider Number
451330
Participating Start Date
9/2/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
GODS COUNTRY PHARMACY
Pharmacy Address
1703 19TH ST
HONDO, TX 78861-2301
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
KEVIN FROSCH, CFO
(830) 426-7898
Contract Pharmacy Representative
GODS Country Pharmacy
Sandra Duran, Pharmacy Tech
(830) 426-5000
Signed By Date
7/17/2018
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