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CLARK PHARMACY
CAH451337-00 Lockney General Hospital District
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Covered Entity Details
Entity Name
Lockney General Hospital District
Subdivision Name
dba W.J. Mangold Memorial Hospital
Type
Critical Access Hospital
340B ID
CAH451337-00
Entity Address
320 N. Main
Lockney, TX 79241
Medicare Provider Number
451337
Participating Start Date
1/1/2013
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CLARK PHARMACY
Pharmacy Address
309 N. MAIN
P.O. BOX 277
LOCKNEY, TX 79241
Pharmacy Comments
Contract Details
Approval Date
1/17/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/8/2016
Ownership change
Contacts
Covered Entity Signing Official
Larry K. Mullins, Administrator
(806) 652-3373 Ext: 204
Contract Pharmacy Representative
Danny Clark, Owner
(806) 652-3353
Signed By Date
1/10/2013
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