340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
STOCKTON PHARMACY
CAH451389-00 PECOS COUNTY MEMORIAL HOSPITAL
Print
Covered Entity Details
Entity Name
PECOS COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451389-00
Entity Address
387 W IH-10
FORT STOCKTON, TX 79735
Medicare Provider Number
451389
Participating Start Date
1/1/2019
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
STOCKTON PHARMACY
Pharmacy Address
616 W DICKINSON BLVD
FORT STOCKTON, TX 79735
Pharmacy Comments
Contract Details
Approval Date
10/16/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Betsy Briscoe, CEO
(432) 336-2004 Ext: 4200
Contract Pharmacy Representative
Stockton Pharmacy
Shashwatkumar Patel, PIC
(832) 512-0974
Signed By Date
10/15/2018
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session