Contract Pharmacy Details

MCWILLIAMS PHARMACY
SCH450073-01 DM Cogdell Memorial Hospital

Covered Entity Details

Entity Name

DM Cogdell Memorial Hospital

Subdivision Name

DM Cogdell Day Surgery

Type

Sole Community Hospital

340B ID

SCH450073-01

Entity Address

1700 Cogdell Blvd
Snyder, TX 79549

Medicare Provider Number

450073

Outpatient Facility Provider Number

Participating Start Date

7/1/2013

Last Recertification Date

8/15/2016

Entity Termination Date

10/1/2016

Pharmacy Details

Pharmacy Name

MCWILLIAMS PHARMACY

Pharmacy Address

3706 COLLEGE AVE
SNYDER, TX 79549

Pharmacy Comments

Contract Details

Approval Date

5/29/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2016
Covered Entity Terminated

Contacts

Covered Entity Signing Official

John H. Everett, COO
(325) 574-7439

Contract Pharmacy Representative

Signed By Date

5/29/2013