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METHODIST COMMUNITY PHARMACY - DALLAS
DSH450723 METHODIST CHARLTON MEDICAL CENTER
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Covered Entity Details
Entity Name
METHODIST CHARLTON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450723
Entity Address
3500 WEST WHEATLAND ROAD
DALLAS, TX 75237-3460
Medicare Provider Number
450723
Participating Start Date
7/1/2005
Last Recertification Date
9/4/2024
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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