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BONHAM FAMILY DRUG
CAH451370-00 Fannin County Hospital Authority
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Covered Entity Details
Entity Name
Fannin County Hospital Authority
Subdivision Name
TMC Bonham Hospital
Type
Critical Access Hospital
340B ID
CAH451370-00
Entity Address
504 Lipscomb St
Bonham, TX 75418
Medicare Provider Number
451370
Participating Start Date
4/1/2014
Last Recertification Date
9/11/2024
Pharmacy Details
Pharmacy Name
BONHAM FAMILY DRUG
Pharmacy Address
MEDICINE SHOPPES, INC
100 E SAM RAYBURN DR
BONHAM, TX 75418-4333
Pharmacy Comments
Contract Details
Approval Date
4/14/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Harley Smith, CEO
(903) 640-7317
Contract Pharmacy Representative
Bonham Family Drug
Bruce McAnally, Owner
(903) 583-7325
Signed By Date
4/14/2016
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