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YOUR HOMETOWN PHARMACY
SCH450370-00 COLUMBUS COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
COLUMBUS COMMUNITY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450370-00
Entity Address
110 SHULT DRIVE
COLUMBUS, TX 78934
Medicare Provider Number
450370
Participating Start Date
1/1/2015
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
YOUR HOMETOWN PHARMACY
Pharmacy Address
COLUMBUS PHARMACY LLC
1206 FANNIN ST.
COLUMBUS, TX 78934
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Vanek, CEO
(979) 493-7561
Contract Pharmacy Representative
Columbus Pharmacy
Paula Grahmann, Owner
(361) 798-5010
Signed By Date
7/17/2018
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