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CVS PHARMACY, INC.
CAH451367-00 ETMC PITTSBURG
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Covered Entity Details
Entity Name
ETMC PITTSBURG
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451367-00
Entity Address
2701 US HIGHWAY 271 NORTH
PITTSBURG, TX 75686
Medicare Provider Number
451367
Participating Start Date
8/24/2010
Last Recertification Date
11/7/2017
Entity Termination Date
4/1/2018
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 07436
601 S JEFFERSON AVE
MT PLEASANT, TX 75455
Pharmacy Comments
Contract Details
Approval Date
1/13/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Perry W. Henderson, Senior Administrator
(903) 946-5501
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
1/13/2014
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