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HEB PHARMACY WAREHOUSE 208
CAH451303-00 LIMESTONE MEDICAL CENTER
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Covered Entity Details
Entity Name
LIMESTONE MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451303-00
Entity Address
701 MCCLINTIC DR
GROESBECK, TX 76642
Medicare Provider Number
451303
Participating Start Date
7/1/2019
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
HEB PHARMACY WAREHOUSE 208
Pharmacy Address
H-E-B, LP
5311 DIETRICH RD STE 100
SAN ANTONIO, TX 78219
Pharmacy Comments
Contract Details
Approval Date
6/30/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Larry N. Price, CEO/ADMINISTRATOR
(254) 729-3281 Ext: 2100
Contract Pharmacy Representative
HEB
Kimberly Lavrack, Director of Third Party
(210) 938-7344
Signed By Date
6/30/2023
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