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BAYLOR SCOTT & WHITE SPECIALTY PHARMACY
DSH450101 HILLCREST BAPTIST MEDICAL CENTER
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Covered Entity Details
Entity Name
HILLCREST BAPTIST MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450101
Entity Address
100 HILLCREST MEDICAL BLVD
WACO, TX 76712
Medicare Provider Number
450101
Participating Start Date
7/1/2005
Last Recertification Date
8/14/2024
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
1/9/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/29/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
GLENN A. ROBINSON, CEO
(254) 202-9414
Contract Pharmacy Representative
BAYLOR SCOTT & WHITE HEALTH
JOHN WILSON, DIRECTOR
(254) 298-6144
Signed By Date
1/9/2020
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