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COVENANT HOSPITAL LEVELLAND
DSH450755A 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
LEVELLAND CLINIC RHC
Type
Disproportionate Share Hospital
340B ID
DSH450755A
Entity Address
1804 S. COLLEGE AVE
LEVELLAND, TX 79336
Medicare Provider Number
450755
Outpatient Facility Provider Number
673988
Participating Start Date
7/1/2011
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
COVENANT HOSPITAL LEVELLAND
Pharmacy Address
1900 COLLEGE AVE
LEVELLAND, TX 79336-6508
Pharmacy Comments
Contract Details
Approval Date
10/3/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/22/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Dolan, CFO
(806) 568-1304
Contract Pharmacy Representative
Marty Cottenior, Pharmacist in charge
(806) 894-4963 Ext: 1314
Signed By Date
10/3/2013
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