340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
MAXWELL PHARMACY
SCH450194-00 East Texas Medical Center Jacksonville
Print
Covered Entity Details
Entity Name
East Texas Medical Center Jacksonville
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450194-00
Entity Address
501 South Ragsdale
Jacksonville, TX 75766
Medicare Provider Number
450194
Participating Start Date
4/1/2013
Last Recertification Date
8/18/2016
Entity Termination Date
7/1/2017
Pharmacy Details
Pharmacy Name
MAXWELL PHARMACY
Pharmacy Address
626 NORTH HIGHWAY 155
P O BOX 726
FRANKSTON, TX 75763
Pharmacy Comments
Contract Details
Approval Date
4/15/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jack R. Endres, Administrator
(903) 541-5100
Contract Pharmacy Representative
Joseph Maxwell Jr., President
(903) 876-2323
Signed By Date
4/15/2013
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session