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CVS PHARMACY, INC.
DSH450686 UNIVERSITY MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450686
Entity Address
602 INDIANA AVE
LUBBOCK, TX 79415
Medicare Provider Number
450686
Participating Start Date
12/1/1992
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 08340
6420 19TH STREET
LUBBOCK, TX 79407
Pharmacy Comments
Contract Details
Approval Date
4/14/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/26/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DAVID ALLISON, CEO
(806) 775-8517
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
4/14/2014
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