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CVS PHARMACY, INC.
DSH450137 BAYLOR SCOTT & WHITE ALL SAINTS MEDICAL CENTER - FORT WORTH
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Covered Entity Details
Entity Name
BAYLOR SCOTT & WHITE ALL SAINTS MEDICAL CENTER - FORT WORTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450137
Entity Address
1400 8TH AVENUE
FORT WORTH, TX 76104
Medicare Provider Number
450137
Participating Start Date
1/1/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 06903
3350 FOREST HILL CIR
FOREST HILL, TX 76140
Pharmacy Comments
Contract Details
Approval Date
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lucy Catala, VP CFO - DFW West Region
(817) 922-1957
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/16/2023
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