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AHSSHC
DSH450369A CHILDRESS REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CHILDRESS REGIONAL MEDICAL CENTER
Subdivision Name
FOX RURAL HEALTH CLINIC
Type
Disproportionate Share Hospital
340B ID
DSH450369A
Entity Address
1001 US HWY 83 NORTH
CHILDRESS, TX 79201
Medicare Provider Number
450369
Outpatient Facility Provider Number
Participating Start Date
4/1/2016
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
AHSSHC
Pharmacy Address
EXPEDIEN RX PHARMACY
5050 WESLEY RD STE 120
APOPKA, FL 32712
Pharmacy Comments
Contract Details
Approval Date
7/2/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JOHN HENDERSON, CEO
(940) 937-9178
Contract Pharmacy Representative
Agape
Trenia Yielding, Executive Director
(407) 357-2601
Signed By Date
7/2/2014
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