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CVS PHARMACY, INC.
DSH450213 UNIVERSITY HEALTH SYSTEM
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Covered Entity Details
Entity Name
UNIVERSITY HEALTH SYSTEM
Subdivision Name
UNIVERSITY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH450213
Entity Address
4502 MEDICAL DRIVE
SAN ANTONIO, TX 78229
Medicare Provider Number
450213
Participating Start Date
10/1/1993
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA CVS/PHARMACY # 10051
2920 EAST SOUTHCROSS BLVD.
SAN ANTONIO, TX 78211
Pharmacy Comments
Contract Details
Approval Date
1/16/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/19/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
MARY ANN MOTE, CHIEF REVENUE OFFICER
(210) 358-2895
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
1/16/2014
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