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LOVELOCK PHARMACY
CAH291304-00 PERSHING GENERAL HOSPITAL
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Covered Entity Details
Entity Name
PERSHING GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH291304-00
Entity Address
855 6TH STREET
LOVELOCK, NV 89419
Medicare Provider Number
291304
Participating Start Date
10/1/2019
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
LOVELOCK PHARMACY
Pharmacy Address
325 11TH STREET, #2
LOVELOCK, NV 89419
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cynthia A Hixenbaugh, CEO
(775) 273-2621 Ext: 1001
Contract Pharmacy Representative
Lovelock Pharmacy
Matthew Christensen, Owner
(775) 273-1700
Signed By Date
10/15/2019
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