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BROOKSHIRE PHARMACY
CAH451385-00 Bosque County Hospital District DBA Goodall-Witcher Hospital
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Covered Entity Details
Entity Name
Bosque County Hospital District DBA Goodall-Witcher Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451385-00
Entity Address
101 Posey Avenue
Clifton, TX 76634
Medicare Provider Number
451385
Participating Start Date
10/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
BROOKSHIRE PHARMACY
Pharmacy Address
900 FM 3220
CLIFTON, TX 76634
Pharmacy Comments
Contract Details
Approval Date
1/7/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Adam B. Willmann, CEO
(254) 675-8322 Ext: 7992
Contract Pharmacy Representative
Brookshire Grocery Company
Neil Ducote, Director of Pharmacy
(903) 600-1376
Signed By Date
1/7/2021
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