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TOWN & COUNTRY DRUG INC
DSH450132 MEDICAL CENTER HOSPITAL
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Covered Entity Details
Entity Name
MEDICAL CENTER HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450132
Entity Address
500 WEST 4TH ST.
ODESSA, TX 79761-5001
Medicare Provider Number
450132
Participating Start Date
4/1/1998
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
TOWN & COUNTRY DRUG INC
Pharmacy Address
2745 N GRANDVIEW AVE
ODESSA, TX 79762-6952
Pharmacy Comments
Contract Details
Approval Date
7/26/2012
Contract Begin Date
7/26/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/5/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ROBERT ABERNETHY, CFO
(432) 640-2407
Contract Pharmacy Representative
Town & Country Drug Inc
Gary Warren, President
(432) 366-2868
Signed By Date
7/6/2012
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