Contract Pharmacy Details

JONES MC CALL PHCY RD
SCH450489-00 MEDICAL ARTS HOSPITAL

Covered Entity Details

Entity Name

MEDICAL ARTS HOSPITAL

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH450489-00

Entity Address

2200 NORTH BRYAN AVE.
LAMESA, TX 79331

Medicare Provider Number

450489

Participating Start Date

7/1/2024

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

JONES MC CALL PHCY RD

Pharmacy Address

JONES MCCALL
1605 N BRYAN AVE.
LAMESA, TX 79331

Pharmacy Comments

Contract Details

Approval Date

6/28/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Letha Hughes, CEO
(806) 872-5727 Ext: 2010

Contract Pharmacy Representative

Reinhard McKinney, Owner
(806) 872-5453

Signed By Date

6/28/2013