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BAYLOR SCOTT & WHITE PHARMACY #227
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
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
4/13/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lucy Catala, VP CFO - DFW West Region
(817) 922-1957
Contract Pharmacy Representative
BAYLOR SCOTT & WHITE HEALTH
JOHN WILSON, DIRECTOR
(254) 298-6144
Signed By Date
4/13/2024
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