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COVENANT HEALTH PHARMACY
DSH450755 Methodist Hospital Levelland (DBA Covenant Hospital Levelland)
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Covered Entity Details
Entity Name
Methodist Hospital Levelland (DBA Covenant Hospital Levelland)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450755
Entity Address
1900 COLLEGE AVE
LEVELLAND, TX 79336
Medicare Provider Number
450755
Participating Start Date
7/1/2011
Last Recertification Date
9/13/2024
Pharmacy Details
Pharmacy Name
COVENANT HEALTH PHARMACY
Pharmacy Address
3615 19TH ST FL MS 1081
LUBBOCK, TX 79410-1203
Pharmacy Comments
Contract Details
Approval Date
4/12/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer Bryan, CFO
(806) 296-4265
Contract Pharmacy Representative
Covenant Medical Center
Dustin Smith, Pharmacy Manager
(806) 725-4761
Signed By Date
4/12/2021
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