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ALBRECHT'S PHARMACY
SCH450052-00 Goodall-Witcher Hospital Authority DBA Goodall-Witcher Hospital
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Covered Entity Details
Entity Name
Goodall-Witcher Hospital Authority DBA Goodall-Witcher Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450052-00
Entity Address
101 Posey Avenue
Clifton, TX 76634
Medicare Provider Number
450052
Participating Start Date
10/1/2013
Last Recertification Date
8/19/2015
Entity Termination Date
10/1/2016
Pharmacy Details
Pharmacy Name
ALBRECHT'S PHARMACY
Pharmacy Address
ALBR5373
506 W 5TH ST
PO BOX 273
CLIFTON, TX 76634-1615
Pharmacy Comments
Contract Details
Approval Date
9/9/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Adam B. Willmann, President/CEO
(254) 675-8322 Ext: 7992
Contract Pharmacy Representative
Clinton Albrecht, Owner
(254) 675-8398
Signed By Date
7/3/2013
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