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CHILDRESS OUTPOST PHARMACY
DSH450369 CHILDRESS REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CHILDRESS REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450369
Entity Address
901 US HWY 83 NORTH
CHILDRESS, TX 79201
Medicare Provider Number
450369
Participating Start Date
4/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CHILDRESS OUTPOST PHARMACY
Pharmacy Address
CHILDRESS OUTPOST PHARMACY LLC
805 US HIGHWAY 83
CHILDRESS, TX 79201-7154
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Emilee Stratton, CFO
(940) 937-9181
Contract Pharmacy Representative
SmartScripts
Todd Thompson, CEO
(319) 330-4328
Signed By Date
4/15/2024
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