340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
BAYLOR SCOTT & WHITE SPECIALTY PHARMACY
DSH450054 SCOTT AND WHITE MEMORIAL HOSPITAL
Print
Covered Entity Details
Entity Name
SCOTT AND WHITE MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450054
Entity Address
2401 S 31ST ST
TEMPLE, TX 76508
Medicare Provider Number
450054
Participating Start Date
4/1/2006
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
BAYLOR SCOTT & WHITE SPECIALTY PHARMACY
Pharmacy Address
BAYLOR SCOTT & WHITE HEALTH ENTERPRISES,
3161 EAGLES NEST ST UNIT 340
ROUND ROCK, TX 78665
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/29/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Shahin Motakef, CEO
(254) 724-6583
Contract Pharmacy Representative
Baylor Scott & White Health
Ping Du, VP Pharmacy Outpatient
(469) 764-1133
Signed By Date
10/11/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session