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THE MEDICINE CABINET
CAH191315-01 HARDTNER MEDICAL CENTER
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Covered Entity Details
Entity Name
HARDTNER MEDICAL CENTER
Subdivision Name
HARDTNER MEDICAL CLINIC
Type
Critical Access Hospital
340B ID
CAH191315-01
Entity Address
1049 NORTH PINE RD
OLLA, LA 71465
Medicare Provider Number
191315
Outpatient Facility Provider Number
193456
Participating Start Date
7/1/2015
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
THE MEDICINE CABINET
Pharmacy Address
7623 HIGHWAY 165
COLUMBIA, LA 71418
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul G. Mathews, Administrator
(318) 495-3131 Ext: 109
Contract Pharmacy Representative
MEDICINE CABINET PHARMACY
DANIELLE O'DONNELL, CO-OWNER/PIC
(318) 649-6410
Signed By Date
10/16/2023
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