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CVS PHARMACY, INC.
DSH450424 Houston Methodist Baytown Hospital
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Covered Entity Details
Entity Name
Houston Methodist Baytown Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450424
Entity Address
4401 GARTH ROAD
BAYTOWN, TX 77521-2122
Medicare Provider Number
450424
Participating Start Date
4/1/2009
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 07296
14630 FM 2100
CROSBY, TX 77532
Pharmacy Comments
Contract Details
Approval Date
7/11/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/27/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JONATHAN D. STURGIS, CFO
(281) 420-8765
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
7/11/2013
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