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GALAXY SPECIALTY PHARMACY
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
2827 BABCOCK ROAD
SAN ANTONIO, TX 78229
Medicare Provider Number
450237
Participating Start Date
7/1/2023
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
GALAXY SPECIALTY PHARMACY
Pharmacy Address
SUN PHARMA LLC
2829 BABCOCK RD STE 120
SAN ANTONIO, TX 78229
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
Galaxy Specialty Pharmacy
LAKSHMI SATHI, AUTHORIZED OFFICIAL
(210) 617-4311
Signed By Date
4/14/2023
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