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CHILDREN'S HEALTH PHARMACY PLANO
PED453302-00 CHILDREN'S MEDICAL CENTER DALLAS
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Covered Entity Details
Entity Name
CHILDREN'S MEDICAL CENTER DALLAS
Subdivision Name
Type
Children's Hospital
340B ID
PED453302-00
Entity Address
1935 MEDICAL DISTRICT DRIVE
DALLAS, TX 75235
Medicare Provider Number
453302
Participating Start Date
4/1/2010
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
CHILDREN'S HEALTH PHARMACY PLANO
Pharmacy Address
CHILDREN'S HEALTH CLINICAL OPERATIONS
7601 PRESTON RD STE L1203
PLANO, TX 75024-3214
Pharmacy Comments
Contract Details
Approval Date
1/6/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David T Berry, CHST President, System Clinical Operations
(214) 456-2143
Contract Pharmacy Representative
Children's Medical Center Plano
Sherryl Escondo, Pharmacist In Charge
(469) 303-2479
Signed By Date
1/6/2020
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