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UNITED PHARMACY #518
SCH450369-00 CHILDRESS COUNTY HOSPITAL DISTRICT DBA CHILDRESS REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CHILDRESS COUNTY HOSPITAL DISTRICT DBA CHILDRESS REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450369-00
Entity Address
901 US Hwy 83
CHILDRESS, TX 79201
Medicare Provider Number
450369
Participating Start Date
10/1/2015
Last Recertification Date
Entity Termination Date
4/1/2016
Pharmacy Details
Pharmacy Name
UNITED PHARMACY #518
Pharmacy Address
2105 AVENUE F NW
CHILDRESS, TX 79201
Pharmacy Comments
Contract Details
Approval Date
10/8/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/29/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JOHN HENDERSON, CEO
(940) 937-9178
Contract Pharmacy Representative
Tim Purser, Director of Pharmacy
(806) 791-7410
Signed By Date
10/8/2015
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