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CALDWELL DRUG, LLC
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
CALDWELL DRUG, LLC
Pharmacy Address
8141 HIGHWAY 165
COLUMBIA, LA 71418-4341
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul G. Mathews, Administrator
(318) 495-3131 Ext: 109
Contract Pharmacy Representative
Caldwell Drug
John Tanner Mcdonald, Owner
(318) 502-4032
Signed By Date
10/14/2024
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