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PREMIER PHARMACY
CAH451309-00 McCamey County Hospital District
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Covered Entity Details
Entity Name
McCamey County Hospital District
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451309-00
Entity Address
2500 Hwy 305 South
McCamey, TX 79752
Medicare Provider Number
451309
Participating Start Date
1/1/2012
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
PREMIER PHARMACY
Pharmacy Address
2425 BABCOCK RD., STE. 108A
SAN ANTONIO, TX 78229
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/20/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jaime Ramirez, NH Administrator
(432) 652-8626 Ext: 218
Contract Pharmacy Representative
Babcock Pharmacy
Dudley Klatt, DOP
(210) 298-9000
Signed By Date
10/15/2019
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