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PHARMACY PLUS # 2
CAH451303-00 LIMESTONE MEDICAL CENTER
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Covered Entity Details
Entity Name
LIMESTONE MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451303-00
Entity Address
701 MCCLINTIC DR
GROESBECK, TX 76642
Medicare Provider Number
451303
Participating Start Date
7/1/2019
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
PHARMACY PLUS # 2
Pharmacy Address
209 N ELLIS ST
GROESBECK, TX 76642-1310
Pharmacy Comments
Contract Details
Approval Date
1/4/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Larry N. Price, CEO/ADMINISTRATOR
(254) 729-3281 Ext: 2100
Contract Pharmacy Representative
Pharmacy Plus
Kelly Gomez, Comptroller
(254) 729-3375
Signed By Date
1/4/2021
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