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PRESCRIPTION SHOP
DSH450755 Methodist Hospital Levelland (DBA Covenant Hospital Levelland)
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Covered Entity Details
Entity Name
Methodist Hospital Levelland (DBA Covenant Hospital Levelland)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450755
Entity Address
1900 COLLEGE AVE
LEVELLAND, TX 79336
Medicare Provider Number
450755
Participating Start Date
7/1/2011
Last Recertification Date
9/13/2024
Pharmacy Details
Pharmacy Name
PRESCRIPTION SHOP
Pharmacy Address
LITTLEFIELD PRESCRIPTION SHOP, LLC
1506 S SUNSET AVE STE A
LITTLEFIELD, TX 79339-7933
Pharmacy Comments
04/16/2012 updated name (was Prescription Shop)
Contract Details
Approval Date
4/14/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/12/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Newman D. Wheeler, COO/CFO
(806) 568-1304
Contract Pharmacy Representative
40755
MARTY COTTENOIR, RPH
(806) 894-4963 Ext: 1314
Signed By Date
4/14/2017
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