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DRIVE IN DRUG STORE
CAH191309-01 HOOD MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
HOOD MEMORIAL HOSPITAL
Subdivision Name
HOOD MEMORIAL HOSPITAL - Rural Health Clinic
Type
Critical Access Hospital
340B ID
CAH191309-01
Entity Address
409 NW CENTRAL AVE
AMITE, LA 70422-2428
Medicare Provider Number
191309
Outpatient Facility Provider Number
193985
Participating Start Date
7/1/2019
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
DRIVE IN DRUG STORE
Pharmacy Address
228 S 1ST ST
AMITE, LA 70422-2704
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Michael Whittington, CEO
(985) 284-2404
Contract Pharmacy Representative
Drive In Drug Store
Gerald Giardina, Owner
(985) 748-8307
Signed By Date
4/15/2020
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