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CVS PHARMACY, INC.
DSH450395 Memorial Medical Center-Livingston
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Covered Entity Details
Entity Name
Memorial Medical Center-Livingston
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450395
Entity Address
1717 Hwy 59 Bypass
Livingston, TX 77351
Medicare Provider Number
450395
Participating Start Date
1/1/2012
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 07229
1500 W CHURCH ST
LIVINGSTON, TX 77351
Pharmacy Comments
Contract Details
Approval Date
4/16/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/20/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kristina Froese, VP of Operations
(936) 329-8726
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/16/2021
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