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UNITED PHARMACY #509
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
UNITED PHARMACY #509
Pharmacy Address
511 COLLEGE AVENUE
LEVELLAND, TX 79336
Pharmacy Comments
Contract Details
Approval Date
4/14/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
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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