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EVERETT'S PHARMACY SONORA
CAH451324-00 LILLIAN M. HUDSPETH MEMORIAL HOSP.
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Covered Entity Details
Entity Name
LILLIAN M. HUDSPETH MEMORIAL HOSP.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451324-00
Entity Address
308 HUDSPETH AVE.
SONORA, TX 76950
Medicare Provider Number
451324
Participating Start Date
7/1/2019
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
EVERETT'S PHARMACY SONORA
Pharmacy Address
417 HWY 277 NORTH
P. O. BOX 527
SONORA, TX 76950-7695
Pharmacy Comments
Contract Details
Approval Date
4/1/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
ROBERT A. PASCASIO, CEO
(325) 387-2521
Contract Pharmacy Representative
Jim Bob Everett, Owner / Pharmacist
(325) 387-2541
Signed By Date
4/1/2014
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