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BAYLOR SCOTT & WHITE PHARMACY #102
DSH450137 BAYLOR SCOTT & WHITE ALL SAINTS MEDICAL CENTER - FORT WORTH
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Covered Entity Details
Entity Name
BAYLOR SCOTT & WHITE ALL SAINTS MEDICAL CENTER - FORT WORTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450137
Entity Address
1400 8TH AVENUE
FORT WORTH, TX 76104
Medicare Provider Number
450137
Participating Start Date
1/1/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
BAYLOR SCOTT & WHITE PHARMACY #102
Pharmacy Address
BAYLOR SCOTT & WHITE HEALTH ENTERPRISES,
1250 8TH AVE STE 125
FORT WORTH, TX 76104
Pharmacy Comments
Contract Details
Approval Date
3/1/2010
Contract Begin Date
3/1/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
STEVEN NEWTON, PRESIDENT
(817) 927-6261
Contract Pharmacy Representative
DENWARD FREEMAN, PRESIDENT
(214) 820-2492
Signed By Date
2/8/2010
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