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HOMETOWN PHARMACY
SCH450539-00 COVENANT HOSPITAL PLAINVIEW
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Covered Entity Details
Entity Name
COVENANT HOSPITAL PLAINVIEW
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450539-00
Entity Address
2601 DIMMITT ROAD
PLAINVIEW, TX 79072
Medicare Provider Number
450539
Participating Start Date
10/1/2013
Last Recertification Date
9/13/2024
Pharmacy Details
Pharmacy Name
HOMETOWN PHARMACY
Pharmacy Address
AGP PHARMACY, LLC
3200 OLTON RD STE B
PLAINVIEW, TX 79072-6653
Pharmacy Comments
Contract Details
Approval Date
9/25/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/10/2017
Agreement registered in error
Contacts
Covered Entity Signing Official
CLAY TAYLOR, CFO/COO
(806) 296-4265
Contract Pharmacy Representative
Pharmacy
Alisa Peters, PIC/Owner
(806) 296-9000
Signed By Date
9/25/2013
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