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CVS PHARMACY, INC.
DSH450237 SANTA ROSA HEALTHCARE
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Covered Entity Details
Entity Name
SANTA ROSA HEALTHCARE
Subdivision Name
CHRISTUS SANTA ROSA HOSPITAL MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH450237
Entity Address
11212 State Highway 151
San Antonio, TX 78251
Medicare Provider Number
450237
Participating Start Date
7/1/2023
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA CVS/PHARMACY #10347
9686 MARBACH ROAD
SAN ANTONIO, TX 78245
Pharmacy Comments
Contract Details
Approval Date
4/20/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Chen, CFO
(210) 321-8031
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/14/2023
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