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AMARILLO PHARMACEUTICAL CARE CTR
DSH450686 UNIVERSITY MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450686
Entity Address
602 INDIANA AVE
LUBBOCK, TX 79415
Medicare Provider Number
450686
Participating Start Date
12/1/1992
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
AMARILLO PHARMACEUTICAL CARE CTR
Pharmacy Address
TX TECH UNIVERSITY HSC
1400 S COULTER ST
STE 1100
AMARILLO, TX 79106
Pharmacy Comments
Contract Details
Approval Date
7/13/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Lowe, Vice President of Support Services
(806) 775-8516
Contract Pharmacy Representative
Texas Tech University Health Sciences Center
Chase Andrew Timms, Pharmacist in Charge
(806) 414-9390
Signed By Date
7/13/2024
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