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HEB PHARMACY #351
RRC450023-00 CITIZENS MEDICAL CENTER
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Covered Entity Details
Entity Name
CITIZENS MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC450023-00
Entity Address
2701 HOSPITAL DRIVE
VICTORIA, TX 77901
Medicare Provider Number
450023
Participating Start Date
7/1/2023
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
HEB PHARMACY #351
Pharmacy Address
103 W ELM ST
EDNA, TX 77957-2703
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/11/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Duane L. Woods, CFO
(361) 572-5009
Contract Pharmacy Representative
HEB
Kimberly Lavrack, Director of Third Party
(210) 938-7344
Signed By Date
10/16/2023
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