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MEDPARK PHARMACY
DSH450272 CHRISTUS Santa Rosa Hospital - San Marcos
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Covered Entity Details
Entity Name
CHRISTUS Santa Rosa Hospital - San Marcos
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450272
Entity Address
1301 Wonder World Drive
San Marcos, TX 78666
Medicare Provider Number
450272
Participating Start Date
10/1/2004
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
MEDPARK PHARMACY
Pharmacy Address
MED-TVZ PHARMACIES INC
2004 MEDICAL PKWY STE A
SAN MARCOS, TX 78666-7585
Pharmacy Comments
Contract Details
Approval Date
7/21/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jesse Sutton, CFO
(512) 753-3505
Contract Pharmacy Representative
Charles Villarreal, Owner
(512) 353-8900
Signed By Date
7/21/2014
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