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CVS PHARMACY, INC.
DSH450424 Houston Methodist Baytown Hospital
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Covered Entity Details
Entity Name
Houston Methodist Baytown Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450424
Entity Address
4401 GARTH ROAD
BAYTOWN, TX 77521-2122
Medicare Provider Number
450424
Participating Start Date
4/1/2009
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 06716
2001 GARTH RD
BAYTOWN, TX 77520
Pharmacy Comments
Contract Details
Approval Date
1/8/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/22/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Becky P Chalupa, Vice President / Chief Nursing Officer
(281) 420-8602
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/8/2021
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