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BOWIE PHARMACY
SCH450241-00 FAITH COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
FAITH COMMUNITY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450241-00
Entity Address
215 Chisholm Trail
JACKSBORO, TX 76458
Medicare Provider Number
450241
Participating Start Date
1/1/2017
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
BOWIE PHARMACY
Pharmacy Address
503 E LONDON ST
BOWIE, TX 76230
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bonnie Blevins, CFO
(940) 550-5704
Contract Pharmacy Representative
Pharmacy
Jimmy Crumpler, Owner
(940) 872-1140
Signed By Date
1/15/2018
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