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LARSON'S PHARMACY #1393
CH0622370 SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER
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Covered Entity Details
Entity Name
SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER
Subdivision Name
SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER
Type
HRSA-Funded Health Center
340B ID
CH0622370
Entity Address
725 PATE STREET
ALBANY, TX 76430-2435
Grant Number
H80CS06460
Participating Start Date
12/16/2005
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
LARSON'S PHARMACY #1393
Pharmacy Address
MAL ENTERPRISES INC
2802 W WALKER STREET
BRECKENRIDGE, TX 76424
Pharmacy Comments
3/21/2013 address update (was 300 WEST HIGHWAY 80 RANGER 76470)
Contract Details
Approval Date
4/12/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/21/2016
Ownership change
Contacts
Covered Entity Signing Official
Dustin Hawk, CEO
(325) 893-4010 Ext: 111
Contract Pharmacy Representative
Larson's
Rene Ramirez, Pharmacy Director
(432) 661-5285
Signed By Date
4/12/2013
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