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BROOKSHIRE PHARMACY #38
CAH191326-01 REEVES MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
REEVES MEMORIAL MEDICAL CENTER
Subdivision Name
REEVES MEMORIAL MEDICAL CENTER - Rural Health Clinic
Type
Critical Access Hospital
340B ID
CAH191326-01
Entity Address
402 SECOND STREET
BERNICE, LA 71222-0302
Medicare Provider Number
191326
Outpatient Facility Provider Number
193416
Participating Start Date
1/1/2018
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
BROOKSHIRE PHARMACY #38
Pharmacy Address
1018 STERLINGTON HWY
FARMERVILLE, LA 71241
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kerry D Goff, CEO
(318) 285-7762
Contract Pharmacy Representative
Brookshires
W Mark Sullivan, Pharmacy Operations
(903) 877-6852
Signed By Date
7/15/2019
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