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FANNIN PHARMACY
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
FANNIN PHARMACY
Pharmacy Address
SAI DRUGS INC
2106 N CENTER ST
BONHAM, TX 75418
Pharmacy Comments
Contract Details
Approval Date
7/18/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Harley Smith, CEO
(903) 640-7317
Contract Pharmacy Representative
Fannin Pharmacy
Raja Avanadula, PIC
(903) 583-8017
Signed By Date
7/18/2017
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