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SANITARIUM DRUG
SCH450348-00 FALLS COMMUNITY HOSPITAL AND CLINIC
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Covered Entity Details
Entity Name
FALLS COMMUNITY HOSPITAL AND CLINIC
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450348-00
Entity Address
322 COLEMAN
MARLIN, TX 76661
Medicare Provider Number
450348
Participating Start Date
1/1/2017
Last Recertification Date
9/15/2021
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
SANITARIUM DRUG
Pharmacy Address
423 LIVE OAK ST
MARLIN, TX 76661
Pharmacy Comments
Contract Details
Approval Date
10/16/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Contacts
Covered Entity Signing Official
WILLIS REESE, ADMINISTRATOR
(254) 803-3561 Ext: 2101
Contract Pharmacy Representative
Thomas Goodrich, President
(254) 883-3541
Signed By Date
10/16/2015
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