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BAYLOR SCOTT & WHITE PHARMACY #108
DSH450079 BAYLOR MEDICAL CENTER AT IRVING
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Covered Entity Details
Entity Name
BAYLOR MEDICAL CENTER AT IRVING
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450079
Entity Address
1901 NORTH MACARTHUR BLVD
IRVING, TX 75061
Medicare Provider Number
450079
Participating Start Date
7/1/2019
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
BAYLOR SCOTT & WHITE PHARMACY #108
Pharmacy Address
BAYLOR SCOTT & WHITE HEALTH ENTERPRISES,
1901 N MACARTHUR BLVD STE 1001
IRVING, TX 75061
Pharmacy Comments
Contract Details
Approval Date
10/14/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
CINDY K. SCHAMP, PRESIDENT
(972) 990-8102
Contract Pharmacy Representative
Laura Longo, Pharmacist in Charge
(972) 579-8100
Signed By Date
10/14/2013
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