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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 # 07299
7202 SAN PEDRO
SAN ANTONIO, TX 78216
Pharmacy Comments
Contract Details
Approval Date
4/14/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/15/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Reed Hurley, Executive Vice President/CFO
(210) 358-2101 Ext: 2141
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/14/2017
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