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BELLE GLADE DRUGS LLC
CAH101309-02 Hendry County Hospital Authority DBA Hendry Regional Medical Center
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Covered Entity Details
Entity Name
Hendry County Hospital Authority DBA Hendry Regional Medical Center
Subdivision Name
Hendry Regional Convenient Care Center
Type
Critical Access Hospital
340B ID
CAH101309-02
Entity Address
450 S. Main St Suite 1
Labelle, FL 33935
Medicare Provider Number
101309
Outpatient Facility Provider Number
103445
Participating Start Date
4/1/2014
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
BELLE GLADE DRUGS LLC
Pharmacy Address
K & M DRUGS
624 S MAIN ST STE 1
BELLE GLADE, FL 33430
Pharmacy Comments
Contract Details
Approval Date
4/11/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/20/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Beltz, CFO
(863) 902-3082
Contract Pharmacy Representative
Juam & John Drugs, Inc
Haitham Kaki, Pharmacy Representative
(863) 983-7277
Signed By Date
4/11/2014
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