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CVS PHARMACY, INC.
DSH450080 TITUS REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
TITUS REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450080
Entity Address
2001 N. JEFFERSON
MT. PLEASANT, TX 75455
Medicare Provider Number
450080
Participating Start Date
7/1/2008
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
CVS/PHARMACY # 11152
1909 WEST BROADWAY ST
CLARKSVILLE, TX 75426
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
8/4/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Terry Scoggin, CEO
(903) 577-6066
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2021
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