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MATTES PHARMACY INC
CAH191301-00 UNION GENERAL HOSPITAL
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Covered Entity Details
Entity Name
UNION GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191301-00
Entity Address
901 JAMES AVE
FARMERVILLE, LA 71241
Medicare Provider Number
191301
Participating Start Date
4/1/2014
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
MATTES PHARMACY INC
Pharmacy Address
314 MAIN ST
P.O. BOX 17
MARION, LA 71260-5252
Pharmacy Comments
Contract Details
Approval Date
10/1/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/18/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
EVALYN ORMOND, CEO
(318) 368-7090
Contract Pharmacy Representative
Mattes Pharmacy
Bruce Matte, RPH / President
(318) 292-4570
Signed By Date
10/1/2015
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