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JONES MC CALL PHCY RD
SCH450489-00 MEDICAL ARTS HOSPITAL
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Covered Entity Details
Entity Name
MEDICAL ARTS HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450489-00
Entity Address
2200 NORTH BRYAN AVE.
LAMESA, TX 79331
Medicare Provider Number
450489
Participating Start Date
7/1/2024
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
JONES MC CALL PHCY RD
Pharmacy Address
JONES MCCALL
1605 N BRYAN AVE.
LAMESA, TX 79331
Pharmacy Comments
Contract Details
Approval Date
4/30/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Freddy Olivarez, CEO
(806) 872-2183
Contract Pharmacy Representative
Jones McCall PHCY
Chad Norris, PIC
(806) 872-5453
Signed By Date
4/8/2024
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