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METHODIST COMMUNITY PHARMACY - DALLAS
DSH450051 METHODIST DALLAS MEDICAL CENTER
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Covered Entity Details
Entity Name
METHODIST DALLAS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450051
Entity Address
1441 NORTH BECKLEY AVENUE
DALLAS, TX 75203
Medicare Provider Number
450051
Participating Start Date
7/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
METHODIST COMMUNITY PHARMACY - DALLAS
Pharmacy Address
MAIN LOBBY B
1441 N BECKLEY AVE
DALLAS, TX 75203
Pharmacy Comments
Contract Details
Approval Date
1/12/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jon T Albrecht, Corporate VP, Chief Pharmacy Officer
(214) 947-2504
Contract Pharmacy Representative
Mehtodist Community Pharmacy, LLC
Melanie Proffitt, Pharmacist-In-Charge
(214) 947-2400
Signed By Date
1/12/2019
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