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MICHAEL'S PRESCRIPTION CORNER
CAH321305-00 NOR-LEA GENERAL HOSPITAL
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Covered Entity Details
Entity Name
NOR-LEA GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH321305-00
Entity Address
1600 N. MAIN AVE
LOVINGTON, NM 88260
Medicare Provider Number
321305
Participating Start Date
9/24/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
MICHAEL'S PRESCRIPTION CORNER
Pharmacy Address
NORTE VISTA
2420 N FOWLER ST
HOBBS, NM 88240
Pharmacy Comments
Contract Details
Approval Date
4/4/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Shaw, CEO
(575) 396-6611 Ext: 1102
Contract Pharmacy Representative
Michael Raburn, Owner
(575) 394-2311
Signed By Date
4/4/2016
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