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Walgreens MFC #21373
DSH450388 METHODIST HOSPITAL
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Covered Entity Details
Entity Name
METHODIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450388
Entity Address
7700 FLOYD CURL DRIVE
SAN ANTONIO, TX 78229-3902
Medicare Provider Number
450388
Participating Start Date
1/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
Walgreens MFC #21373
Pharmacy Address
4100 Dale Earnhardt Way
200
Northlake, TX 76262
Pharmacy Comments
Contract Details
Approval Date
4/11/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Enrique Bernal, DCFO
(210) 575-0235
Contract Pharmacy Representative
Walgreens
Ruthann Archer, Director of 340B Operations
(847) 964-8116
Signed By Date
4/11/2025
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