340B Drug Pricing Program Database
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BRICK STREET PHARMACY
DSH450102 CHRISTUS MOTHER FRANCES HOSP-TYLER
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Covered Entity Details
Entity Name
CHRISTUS MOTHER FRANCES HOSP-TYLER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450102
Entity Address
800 EAST DAWSON
TYLER, TX 75701
Medicare Provider Number
450102
Participating Start Date
3/10/2022
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
BRICK STREET PHARMACY
Pharmacy Address
314 W RUSK ST
TYLER, TX 75701-1513
Pharmacy Comments
Contract Details
Approval Date
3/10/2022
Contract Begin Date
3/10/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/7/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Elizabeth Pulliam, Chief Financial Officer
(903) 606-4102
Contract Pharmacy Representative
Brick Street Pharmacy
Jeffrey Abeldt, Pharmacist in Charge
(903) 533-8155
Signed By Date
3/1/2022
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