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BAGGETT PHARMACY
CH061412A CACTUS HEALTH SERVICES INC
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Covered Entity Details
Entity Name
CACTUS HEALTH SERVICES INC
Subdivision Name
Cactus Health Services, Inc.
Type
HRSA-Funded Health Center
340B ID
CH061412A
Entity Address
700 N. Main
Fort Stockton, TX 79735
Grant Number
H80CS01426
Participating Start Date
7/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
BAGGETT PHARMACY
Pharmacy Address
509 N MAIN ST
FORT STOCKTON, TX 79735-5623
Pharmacy Comments
Contract Details
Approval Date
4/23/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/10/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Corkrum, CEO
(432) 336-8110
Contract Pharmacy Representative
Baggett Pharmacy
Mario Juarez, Owner PIC
(432) 336-2297
Signed By Date
4/23/2015
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