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HEB SPECIALTY PHARMACY #701
CAH451303-04 LIMESTONE MEDICAL CENTER
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Covered Entity Details
Entity Name
LIMESTONE MEDICAL CENTER
Subdivision Name
SOUTH LIMESTONE HOSPITAL DISTRICT - RETTIG FAMILY HEALTH CARE (RHC)
Type
Critical Access Hospital
340B ID
CAH451303-04
Entity Address
204 W TRINITY STREET
RETTIG FAM HEALTH CRE A LIMESTONE MED CENT CLNC
GROESBECK, TX 76642-1324
Medicare Provider Number
451303
Outpatient Facility Provider Number
673480
Participating Start Date
7/1/2022
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
HEB SPECIALTY PHARMACY #701
Pharmacy Address
3503 FREDERICKSBURG RD
STE 450
SAN ANTONIO, TX 78201
Pharmacy Comments
Contract Details
Approval Date
1/9/2024
Contract Begin Date
4/1/2024
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 Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578
Signed By Date
1/9/2024
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