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SPECIALTY THERAPEUTIC CARE
DSH030013 YUMA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
YUMA REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030013
Entity Address
2400 S Avenue A
Yuma, AZ 85364
Medicare Provider Number
030013
Participating Start Date
1/1/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
SPECIALTY THERAPEUTIC CARE
Pharmacy Address
1311 W SAM HOUSTON PKWY N STE 150
HOUSTON, TX 77043-4015
Pharmacy Comments
Contract Details
Approval Date
4/13/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Willie, CFO
(928) 336-7015
Contract Pharmacy Representative
specialty therapy care location of AcariaHealth
Shubha Vaidya, Pharmacist in Charge
(832) 300-1200
Signed By Date
4/13/2020
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