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BAYLOR SCOTT & WHITE PHARMACY #227
DSH450101 HILLCREST BAPTIST MEDICAL CENTER
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Covered Entity Details
Entity Name
HILLCREST BAPTIST MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450101
Entity Address
100 HILLCREST MEDICAL BLVD
WACO, TX 76712
Medicare Provider Number
450101
Participating Start Date
7/1/2005
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
BAYLOR SCOTT & WHITE PHARMACY #227
Pharmacy Address
BAYLOR SCOTT & WHITE HEALTH ENTERPRISES,
937 CANYON CREEK DR
TEMPLE, TX 76502
Pharmacy Comments
Contract Details
Approval Date
4/9/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shellie Mach, CFO
(254) 202-9414
Contract Pharmacy Representative
Baylor Scott & White Health
Ping Du, VP Pharmacy Outpatient
(469) 764-1133
Signed By Date
4/9/2024
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