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CLINIC PHARMACY
CAH451313-00 FISHER COUNTY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
FISHER COUNTY HOSPITAL DISTRICT
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451313-00
Entity Address
774 STATE HIGHWAY 70
ROTAN, TX 79546
Medicare Provider Number
451313
Participating Start Date
10/1/2016
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
CLINIC PHARMACY
Pharmacy Address
774 STATE HIGHWAY 70 N
ROTAN, TX 79546-6918
Pharmacy Comments
Contract Details
Approval Date
1/27/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Leanne Martinez, CEO
(325) 735-2256 Ext: 284
Contract Pharmacy Representative
Toutbon, LLC
Mikel McWilliams, Owner
(325) 573-7582
Signed By Date
1/27/2017
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