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CVS PHARMACY, INC.
DSH450184 MEMORIAL HERMANN HOSPITAL SYSTEM
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Covered Entity Details
Entity Name
MEMORIAL HERMANN HOSPITAL SYSTEM
Subdivision Name
Memorial Hermann Southwest Hospital
Type
Disproportionate Share Hospital
340B ID
DSH450184
Entity Address
7600 Beechnut
Houston, TX 77074
Medicare Provider Number
450184
Participating Start Date
2/7/2018
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 06800
15270 HWY 105 WEST
MONTGOMERY, TX 77356
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
4/17/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rebecca Tucker, VP, Finance
(713) 456-5340
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2020
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