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WAL-MART PHARMACY 10-0077
CAH451374-00 Baylor Scott & White Medical Center- Taylor
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Covered Entity Details
Entity Name
Baylor Scott & White Medical Center- Taylor
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451374-00
Entity Address
305 Mallard Ln
Taylor, TX 76574
Medicare Provider Number
451374
Participating Start Date
7/1/2014
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0077
Pharmacy Address
3701 NORTH MAIN STREET
TAYLOR, TX 76574
Pharmacy Comments
Contract Details
Approval Date
8/21/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ernie Bovio, CEO
(325) 247-7868
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
8/21/2014
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