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HEB PHARMACY #696
CAH451374-00 Baylor Scott & White Medical Center- Taylor
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Covered Entity Details
Entity Name
Baylor Scott & White Medical Center- Taylor
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451374-00
Entity Address
305 Mallard Ln
Taylor, TX 76574
Medicare Provider Number
451374
Participating Start Date
7/1/2014
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
HEB PHARMACY #696
Pharmacy Address
5000 GATTIS SCHOOL RD
HUTTO, TX 78634
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tim Tarbell, VP Operations
(512) 654-6297
Contract Pharmacy Representative
HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578
Signed By Date
7/15/2022
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