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CORNER DRUG
CAH451342-00 MITCHELL COUNTY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
MITCHELL COUNTY HOSPITAL DISTRICT
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451342-00
Entity Address
997 WEST IH 20
COLORADO CITY, TX 79512
Medicare Provider Number
451342
Participating Start Date
7/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
CORNER DRUG
Pharmacy Address
1001 HICKORY
P O BOX 1267
COLORADO CITY, TX 79512
Pharmacy Comments
Contract Details
Approval Date
4/12/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ROBBIE DEWBERRY, CHIEF EXECUTIVE OFFICER
(325) 728-3431 Ext: 7106
Contract Pharmacy Representative
Chaney Family Pharmacy LLC
Jody Chaney, President
(325) 728-8030
Signed By Date
4/12/2018
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