340B Drug Pricing Program Database

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)

Approval Date

12/3/2012

Contract Begin Date

1/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/7/2016
Ownership change

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

10/12/2012