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CVS PHARMACY, INC.
DSH450848 Memorial Hermann Sugar Land Hospital
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Covered Entity Details
Entity Name
Memorial Hermann Sugar Land Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450848
Entity Address
17500 West Grand Parkway
Sugar Land, TX 77479
Medicare Provider Number
450848
Participating Start Date
1/1/2012
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA CVS/PHARMACY #10603
15027 STATE HWY 6
ROSHARON, TX 77583
Pharmacy Comments
Contract Details
Approval Date
1/19/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert C Ogden, Associate Vice President of Finance
(713) 456-5111
Contract Pharmacy Representative
Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118
Signed By Date
1/19/2021
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