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PRESCRIPTION SHOP MARFA
CHC08235-00 Preventative Care Health Services, INC.
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Covered Entity Details
Entity Name
Preventative Care Health Services, INC.
Subdivision Name
Preventative Care Health Services, INC.
Type
HRSA-Funded Health Center
340B ID
CHC08235-00
Entity Address
406 S. SUMMER STREET
MARFA, TX 79843
Grant Number
H80CS08235
Participating Start Date
10/1/2013
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
PRESCRIPTION SHOP MARFA
Pharmacy Address
105-2 E. OAK STREET
PO BOX 1216
MARFA, TX 79843
Pharmacy Comments
Contract Details
Approval Date
1/10/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Linda Molinar, CEO
(432) 837-4812 Ext: 203
Contract Pharmacy Representative
Prescription Shop Marfa
Robert Fast, Pharmacist
(432) 729-4244
Signed By Date
1/10/2019
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