340B Drug Pricing Program Database
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HEALTHCARE CENTER PHARMACY
CAH451319-00 MOTHER FRANCES HOSPITAL-JACKSONVILLE
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Covered Entity Details
Entity Name
MOTHER FRANCES HOSPITAL-JACKSONVILLE
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451319-00
Entity Address
2026 S.JACKSON ST.
JACKSONVILLE, TX 75766
Medicare Provider Number
451319
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
HEALTHCARE CENTER PHARMACY
Pharmacy Address
2604 ST MICHAEL DRIVE, SUITE 200
TEXARKANA, TX 75503
Pharmacy Comments
Contract Details
Approval Date
6/24/2020
Contract Begin Date
6/24/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/20/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Barry D. Lofquist, Administrator
(903) 541-4505
Contract Pharmacy Representative
Christus Health
Dustyn Tysdal, Director of Pharmacy
(830) 643-5377
Signed By Date
6/24/2020
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