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BAYLOR SCOTT & WHITE PHARMACY #279
CAH451397-00 SCOTT & WHITE HOSPITAL BRENHAM
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Covered Entity Details
Entity Name
SCOTT & WHITE HOSPITAL BRENHAM
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451397-00
Entity Address
700 MEDICAL PARKWAY
Brenham, TX 77833
Medicare Provider Number
451397
Participating Start Date
7/29/2022
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
BAYLOR SCOTT & WHITE PHARMACY #279
Pharmacy Address
BAYLOR SCOTT & WHITE HEALTH ENTERPRISES,
207 E ACADEMY ST
BRENHAM, TX 77833
Pharmacy Comments
Contract Details
Approval Date
7/25/2022
Contract Begin Date
7/29/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason Jennings, President
(979) 207-4043
Contract Pharmacy Representative
BAYLOR SCOTT & WHITE HEALTH
JOHN WILSON, DIRECTOR
(254) 298-6144
Signed By Date
7/20/2022
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