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HEB PHARMACY WAREHOUSE 208
CAH451330-00 MEDINA COUNTY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
MEDINA COUNTY HOSPITAL DISTRICT
Subdivision Name
MEDINA REGIONAL HOSPITAL
Type
Critical Access Hospital
340B ID
CAH451330-00
Entity Address
3100 AVENUE E
HONDO, TX 78861
Medicare Provider Number
451330
Participating Start Date
9/2/2010
Last Recertification Date
8/27/2024
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
KEVIN FROSCH, CFO
(830) 426-7898
Contract Pharmacy Representative
HEB
Kimberly Lavrack, Director of Third Party
(210) 938-7344
Signed By Date
6/30/2023
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