Contract Pharmacy Details

GERMAN DOBSON CVS, L.L.C.
DSH450051 METHODIST DALLAS MEDICAL CENTER

Covered Entity Details

Entity Name

METHODIST DALLAS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH450051

Entity Address

1441 NORTH BECKLEY AVENUE
DALLAS, TX 75203

Medicare Provider Number

450051

Participating Start Date

7/1/2005

Last Recertification Date

9/6/2024

Pharmacy Details

Pharmacy Name

GERMAN DOBSON CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07841
4365 N ORACLE RD
TUCSON, AZ 85705

Pharmacy Comments

Contract Details

Approval Date

7/15/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jon T Albrecht, Corporate VP, Chief Pharmacy Officer
(214) 947-2504

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/15/2020

340B Drug Pricing Program Database