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RANDALLS FOOD AND DRUGS LP
DSH450018 UNIVERSITY OF TEXAS MEDICAL BRANCH
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Covered Entity Details
Entity Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450018
Entity Address
301 UNIVERSITY BLVD
GALVESTON, TX 77555
Medicare Provider Number
450018
Participating Start Date
4/1/1994
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
RANDALLS FOOD AND DRUGS LP
Pharmacy Address
RANDALLS PHARMACY #1031
2931 CENTRAL CITY AVE
GALVESTON, TX 77551
Pharmacy Comments
06/05/2012 pharmacy name change (was Safeway #1031)
Contract Details
Approval Date
5/11/2012
Contract Begin Date
5/11/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
William R. Elger, EVP and Chief Business and Finance Officer
(409) 266-2006
Contract Pharmacy Representative
Safeway
Merle Jarvill, Director, Managed Care
(623) 869-4260
Signed By Date
4/20/2012
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