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QUALITY PHARMACY INC
SCH450235-01 GONZALES HEALTHCARE SYSTEMS
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Covered Entity Details
Entity Name
GONZALES HEALTHCARE SYSTEMS
Subdivision Name
Sievers Medical Clinic - Waelder - Rural Health Clinic
Type
Sole Community Hospital
340B ID
SCH450235-01
Entity Address
1818 E US Hwy 90
Waelder, TX 78959
Medicare Provider Number
450235
Outpatient Facility Provider Number
453481
Participating Start Date
5/13/2020
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
QUALITY PHARMACY INC
Pharmacy Address
408 N AVENUE B
P.O.BOX 697
SHINER, TX 77984-7126
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael La Coste, CEO
(830) 672-7581
Contract Pharmacy Representative
Mohrmann's Drug Store
Ray Raley, Owner
(830) 857-0881
Signed By Date
10/14/2022
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