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MEDICAL CENTER FAMILY PHARM
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
MEDICAL CENTER FAMILY PHARM
Pharmacy Address
MEDICAL CENTER FAMILY PHCY, INC.
2001 N JEFFERSON AVE STE 132
MOUNT PLEASANT, TX 75455-2387
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/18/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Terry Scoggin, CEO
(903) 577-6066
Contract Pharmacy Representative
Medical Center Family Pharmacy
Molly Glass, Pharmacy Manager
(903) 572-6418
Signed By Date
1/17/2023
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