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BROOKSHIRE PHARMACY #58
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
BROOKSHIRE PHARMACY #58
Pharmacy Address
306 STATE HWY 37 SOUTH
BOX 513
MOUNT VERNON, TX 75457
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
8/4/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/3/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Terry Scoggin, CEO
(903) 577-6066
Contract Pharmacy Representative
Brookshire Grocery Company
Neil Ducote, Director of Pharmacy
(903) 600-1376
Signed By Date
7/15/2021
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