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HEB PHARMACY WAREHOUSE 208
SCH670108-00 BAYLOR SCOTT & WHITE - MARBLE FALLS
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Covered Entity Details
Entity Name
BAYLOR SCOTT & WHITE - MARBLE FALLS
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH670108-00
Entity Address
810 W HIGHWAY 71
MARBLE FALLS, TX 78654
Medicare Provider Number
670108
Participating Start Date
4/1/2024
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
HEB PHARMACY WAREHOUSE 208
Pharmacy Address
H-E-B, LP
5311 DIETRICH RD STE 100
SAN ANTONIO, TX 78219
Pharmacy Comments
Contract Details
Approval Date
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Ols, President
(830) 201-8679
Contract Pharmacy Representative
HEB
Kimberly Lavrack, Director of Third Party
(210) 938-7344
Signed By Date
1/14/2025
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