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CENTERWELL PHARMACY, INC.
CAH191315-00 HARDTNER MEDICAL CENTER
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Covered Entity Details
Entity Name
HARDTNER MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191315-00
Entity Address
1102 N. PINE ROAD
OLLA, LA 71465
Medicare Provider Number
191315
Participating Start Date
4/1/2015
Last Recertification Date
9/24/2024
Pharmacy Details
Pharmacy Name
CENTERWELL PHARMACY, INC.
Pharmacy Address
10737 MARKS WAY
MIRAMAR, FL 33025
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/7/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Paul G. Mathews, Administrator
(318) 495-3131 Ext: 109
Contract Pharmacy Representative
Centerwell
Shelley Duke, Director, Specialty Pharmacy Contracting and Infusion
(502) 994-8732
Signed By Date
10/15/2021
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