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STRIPLING'S PHARMACY
DSH450508 LION STAR NACOGDOCHES MEMORIAL HOSP
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Covered Entity Details
Entity Name
LION STAR NACOGDOCHES MEMORIAL HOSP
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450508
Entity Address
1204 NORTH MOUND STREET
NACOGDOCHES, TX 75961
Medicare Provider Number
450508
Participating Start Date
7/1/2024
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
STRIPLING'S PHARMACY
Pharmacy Address
STRIPLINGS PHARMACY, LLC
1205 N MOUND ST
NACOGDOCHES, TX 75961-4028
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rhonda McCabe, CEO
(936) 568-8523
Contract Pharmacy Representative
Nacogdoches Memorial Hospital
David Schaefer, DOP
(936) 568-8415
Signed By Date
10/15/2024
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