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REUSS PHARMACY
DSH450597A DEWITT MEDICAL DISTRICT DBA CUERO REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
DEWITT MEDICAL DISTRICT DBA CUERO REGIONAL HOSPITAL
Subdivision Name
DEWITT MEDICAL DISTRICT - Parkside Family Clinic
Type
Disproportionate Share Hospital
340B ID
DSH450597A
Entity Address
1109E BROADWAY ST
PARKSIDE FAMILY CLINIC
CUERO, TX 77954-2108
Medicare Provider Number
450597
Outpatient Facility Provider Number
673423
Participating Start Date
7/1/2016
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
REUSS PHARMACY
Pharmacy Address
515 N ESPLANADE ST
CUERO, TX 77954-3603
Pharmacy Comments
Contract Details
Approval Date
10/11/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/5/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
GREG PRITCHETT, CFO
(361) 275-0504
Contract Pharmacy Representative
Reuss Pharmacy
Guarav Midha, Pharmacist in Charge
(325) 275-3411
Signed By Date
10/11/2016
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