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MCWILLIAMS PHARMACY
CAH451342-00 MITCHELL COUNTY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
MITCHELL COUNTY HOSPITAL DISTRICT
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451342-00
Entity Address
997 WEST IH 20
COLORADO CITY, TX 79512
Medicare Provider Number
451342
Participating Start Date
7/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
MCWILLIAMS PHARMACY
Pharmacy Address
3706 COLLEGE AVE
SNYDER, TX 79549
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/9/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ROBBIE DEWBERRY, CHIEF EXECUTIVE OFFICER
(325) 728-3431 Ext: 7106
Contract Pharmacy Representative
Signed By Date
7/15/2016
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