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BAYLOR SCOTT & WHITE PHARMACY #108
DSH450079 BAYLOR MEDICAL CENTER AT IRVING
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Covered Entity Details
Entity Name
BAYLOR MEDICAL CENTER AT IRVING
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450079
Entity Address
1901 NORTH MACARTHUR BLVD
IRVING, TX 75061
Medicare Provider Number
450079
Participating Start Date
7/1/2019
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
BAYLOR SCOTT & WHITE PHARMACY #108
Pharmacy Address
BAYLOR SCOTT & WHITE HEALTH ENTERPRISES,
1901 N MACARTHUR BLVD STE 1001
IRVING, TX 75061
Pharmacy Comments
Contract Details
Approval Date
1/9/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CINDY K. SCHAMP, PRESIDENT
(972) 990-8102
Contract Pharmacy Representative
Baylor Health Enterprises
Eric Gaines, Dir Outpatient Pharmacy
(469) 814-5798
Signed By Date
1/9/2020
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