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GATESVILLE DRUG CO
CAH451379-00 CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
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Covered Entity Details
Entity Name
CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451379-00
Entity Address
1507 W MAIN ST
GATESVILLE, TX 76528-1024
Medicare Provider Number
451379
Participating Start Date
9/29/2010
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
GATESVILLE DRUG CO
Pharmacy Address
2513 S STATE HIGHWAY 36
GATESVILLE, TX 76528
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
7/15/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
6/22/2011
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