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BROOKSHIRE PHARMACY #38
CAH191326-00 REEVES MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
REEVES MEMORIAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191326-00
Entity Address
409 FIRST ST.
BERNICE, LA 71222
Medicare Provider Number
191326
Participating Start Date
1/1/2018
Last Recertification Date
8/22/2024
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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