Contract Pharmacy Details

CUB DRUG
CAH451354-01 OLNEY HAMILTON HOSPITAL DISTRICT

Covered Entity Details

Entity Name

OLNEY HAMILTON HOSPITAL DISTRICT

Subdivision Name

LOVETT-MEREDITH RURAL HEALTH CLINIC

Type

Critical Access Hospital

340B ID

CAH451354-01

Entity Address

100 S. AVE M
OLNEY, TX 76374

Medicare Provider Number

451354

Outpatient Facility Provider Number

458863

Participating Start Date

9/14/2010

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

CUB DRUG

Pharmacy Address

116 E MAIN ST
OLNEY, TX 76374-1922

Pharmacy Comments

Contract Details

Approval Date

7/5/2012

Contract Begin Date

7/5/2012

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

MICHAEL HUFF, ADMINISTRATOR
(940) 564-5521

Contract Pharmacy Representative

RANDAL EDWARD WHITMIRE, PHARMACIST
(940) 564-5551

Signed By Date

6/25/2012