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MAURICEVILLE FAMILY PHARMACY
CHC28977-00 TRIANGLE AREA NETWORK, INC.
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Covered Entity Details
Entity Name
TRIANGLE AREA NETWORK, INC.
Subdivision Name
Triangle Area Network - Orange
Type
HRSA-Funded Health Center
340B ID
CHC28977-00
Entity Address
3727 N. 16th St.
Orange, TX 77632
Grant Number
H80CS28977
Participating Start Date
4/1/2017
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
MAURICEVILLE FAMILY PHARMACY
Pharmacy Address
10897 HWY 12
PO BOX 1149
MAURICEVILLE, TX 77626
Pharmacy Comments
Contract Details
Approval Date
1/5/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/3/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
AMANDA GIBSON, MEDICAL BILLING COORDINATOR
(409) 832-8338 Ext: 268
Contract Pharmacy Representative
TREY HANEY, OWNER
(409) 454-0580
Signed By Date
1/5/2017
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