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PROACT PHARMACY SERVICES, INC.
CAH451387-00 Uvalde Memorial Hospital
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Covered Entity Details
Entity Name
Uvalde Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451387-00
Entity Address
1025 Garner Field Road
Uvalde, TX 78801
Medicare Provider Number
451387
Participating Start Date
7/1/2017
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
PROACT PHARMACY SERVICES, INC.
Pharmacy Address
1226 US HIGHWAY 11
GOUVERNEUR, NY 13642
Pharmacy Comments
Contract Details
Approval Date
7/28/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/8/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Valerie J. Lopez, Chief Financial Officer
(830) 278-6251 Ext: 1173
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
7/28/2017
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