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CVS PHARMACY, INC.
SCH450010-00 United Regional Health Care System
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Covered Entity Details
Entity Name
United Regional Health Care System
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450010-00
Entity Address
1600 11th Street
Wichita Falls, TX 76301
Medicare Provider Number
450010
Participating Start Date
1/1/2013
Last Recertification Date
9/14/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
CVS/PHARMACY # 4880
805 W. BUSINESS HWY 380
DECATUR, TX 76234
Pharmacy Comments
Contract Details
Approval Date
4/9/2020
Contract Begin Date
4/21/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Robert M. Pert, Chief Financial Officer
(940) 764-3023
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/9/2020
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