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WAL-MART PHARMACY 10-5315
CAH451374-00 Baylor Scott & White Medical Center- Taylor
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Covered Entity Details
Entity Name
Baylor Scott & White Medical Center- Taylor
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451374-00
Entity Address
305 Mallard Ln
Taylor, TX 76574
Medicare Provider Number
451374
Participating Start Date
7/1/2014
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tim Tarbell, VP Operations
(512) 654-6297
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/15/2021
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