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THE MEDICINE PLACE
CAH451342-00 MITCHELL COUNTY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
MITCHELL COUNTY HOSPITAL DISTRICT
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451342-00
Entity Address
997 WEST IH 20
COLORADO CITY, TX 79512
Medicare Provider Number
451342
Participating Start Date
7/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
THE MEDICINE PLACE
Pharmacy Address
2250 CHESTNUT ST.
COLORADO CITY, TX 79512
Pharmacy Comments
Contract Details
Approval Date
1/10/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ROBBIE DEWBERRY, CHIEF EXECUTIVE OFFICER
(325) 728-3431 Ext: 7106
Contract Pharmacy Representative
The Medicine Place
Paul Johnson, Pharmacist, Owner
(325) 728-3489
Signed By Date
1/10/2020
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