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QRC HEALTHMART PHARMACY
CAH451330-00 MEDINA COUNTY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
MEDINA COUNTY HOSPITAL DISTRICT
Subdivision Name
MEDINA REGIONAL HOSPITAL
Type
Critical Access Hospital
340B ID
CAH451330-00
Entity Address
3100 AVENUE E
HONDO, TX 78861
Medicare Provider Number
451330
Participating Start Date
9/2/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
QRC HEALTHMART PHARMACY
Pharmacy Address
ALAMO HEALTH LLC
408 US HIGHWAY 90 W STE B
CASTROVILLE, TX 78009-4548
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KEVIN FROSCH, CFO
(830) 426-7898
Contract Pharmacy Representative
QRC Healthmart Pharmacy
Preveen Daida, Owner
(830) 931-2116
Signed By Date
10/15/2020
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