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LOWE'S MARKETPLACE #45
CAH451373-00 Ward Memorial Hospital
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Covered Entity Details
Entity Name
Ward Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451373-00
Entity Address
406 S Gary St
Monahans, TX 79756-0040
Medicare Provider Number
451373
Participating Start Date
7/1/2014
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
LOWE'S MARKETPLACE #45
Pharmacy Address
1201 STOCKTON AVE
MONAHANS, TX 79756
Pharmacy Comments
Contract Details
Approval Date
10/15/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Leticia C. Rodriguez, CEO
(432) 943-2511 Ext: 176
Contract Pharmacy Representative
Ronnie Rogers, CFO
(806) 385-3366
Signed By Date
10/15/2014
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