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TEXAS HEALTH RESOURCES INFUSION PHARMACY
DSH450064 TEXAS HEALTH ARLINGTON MEMORIAL HOSP
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Covered Entity Details
Entity Name
TEXAS HEALTH ARLINGTON MEMORIAL HOSP
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450064
Entity Address
800 W RANDOL MILL ROAD
ARLINGTON, TX 76012
Medicare Provider Number
450064
Participating Start Date
4/1/2023
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
TEXAS HEALTH RESOURCES INFUSION PHARMACY
Pharmacy Address
1100 BRIDGEWOOD DR, STE 107
FORT WORTH, TX 76112
Pharmacy Comments
Contract Details
Approval Date
10/13/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Blake Kretz, President
(817) 960-6539
Contract Pharmacy Representative
Texas Health
Ted Menard, Director Pharmacy
(682) 236-2423
Signed By Date
10/13/2017
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