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CVS PHARMACY, INC.
DSH450154 Val Verde Regional Medical Center
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Covered Entity Details
Entity Name
Val Verde Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450154
Entity Address
801 Bedell Avenue
Del Rio, TX 78840
Medicare Provider Number
450154
Participating Start Date
1/1/2012
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
225 HARPERS LANDING BLVD
CONROE, TX 77385
Pharmacy Comments
Contract Details
Approval Date
1/3/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/24/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lisa Medovich, CFO
(830) 778-3610
Contract Pharmacy Representative
CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
1/3/2015
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