Contract Pharmacy Details

LIBERTY DRUG
CAH451308-00 YOAKUM COUNTY HOSPITAL

Covered Entity Details

Entity Name

YOAKUM COUNTY HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH451308-00

Entity Address

412 MUSTANG AVE
DENVER CITY, TX 79323

Medicare Provider Number

451308

Participating Start Date

8/12/2010

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

LIBERTY DRUG

Pharmacy Address

403 MUSTANG AVENUE
DENVER CITY, TX 79323

Pharmacy Comments

Contract Details

Approval Date

12/6/2012

Contract Begin Date

1/1/2013

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Chris Ekrem, CEO
(806) 592-2121

Contract Pharmacy Representative

Suryanarayana Saji, PIC
(806) 592-2765

Signed By Date

10/15/2012