Covered Entity Details

DSH450034P CHRISTUS HOSPITAL (Terminated) - information as of 4/25/2025 6:34:38 PM

Main Details

Name

CHRISTUS HOSPITAL

Subdivision Name

CHRISTUS SOUTHEAST TEXAS St. Mary-Radiology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH450034P

Medicare Provider Number

450034

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/13/2015

Participating Start Date

4/1/2015

Participating Approval Date

3/12/2015

Last Recertification Date

8/30/2016

Termination Date
Termination Reason

1/1/2018
DSH percentage below statutory minimum

Contacts

Authorizing Official

CHRISTUS Hospital
Paul Trevino, CEO, CHRISTUS Health Southeast Texas
(409) 899-7102

Primary Contact

CHRISTUS Hospital
Tommy Welch, Director of Pharmacy
(409) 899-7042

Addresses

Street Address

3600 GATES BLVD
PORT ARTHUR, TX 77642-3858

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
TX	138296208,138296207,138296206
		1679557888

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH450034AA	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Minor Care Center St. Mary - Minor Care	8445 Memorial Blvd., Suite 600	Port Arthur	TX	Terminated
DSH450034AB	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Minor Care Center St. Elizabeth - Minor Care	3939 Dowlen Rd., Suite 19	BEAUMONT	TX	Terminated
DSH450034AC	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Minor Care Center St. Elizabeth - Minor Care Fast Track	3939 Dowlen Rd., Suite 19	BEAUMONT	TX	Terminated
DSH450034AD	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Center St. Mary-Hyperbaric & Wound Care Center	755 N. 11th St., Suite D1001	BEAUMONT	TX	Terminated
DSH450034AE	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Pavillion St. Elizabeth - Hyperbaric and Wound Care Center	755 N. 11th St., Suite D1001	BEAUMONT	TX	Active
DSH450034AF	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Orthopedic Specialty Center - Day Surgery	3650 LAUREL STREET	BEAUMONT	TX	Active
DSH450034AG	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Orthopedic Specialty Center Mid County	2501 Jimmy Johnson Blvd., Ste 400	Port Arthur	TX	Terminated
DSH450034AH	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Orthopedic Specialty Center - Physical Therapy	3650 LAUREL STREET	BEAUMONT	TX	Active
DSH450034AJ	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Orthopedic Specialty Center - OP Radiology	3650 LAUREL STREET	BEAUMONT	TX	Active
DSH450034AK	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Orthopedic Specialty Center -BBJ Beaumont	3650 LAUREL STREET	BEAUMONT	TX	Active
DSH450034AL	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Bariatric Center St. Elizabeth	3030 NORTH STREET SUITE 340	BEAUMONT	TX	Active
DSH450034AM	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Center St. Mary - Respiratory	8801 9th Avenue	PORT ARTHUR	TX	Active
DSH450034AN	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Center for Health Management St. Mary	4640 Ninth Ave, Suite 103	Port Arthur	TX	Terminated
DSH450034AP	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Minor Care Center St. Mary - Minor Care Fast Track	8445 Memorial Blvd., Suite 600	PORT ARTHUR	TX	Terminated
DSH450034AQ	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-LDRP	3600 GATES BLVD	PORT ARTHUR	TX	Terminated
DSH450034AR	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS HEALTH SOUTHEAST TEXAS / Med/Surg - Observation Beds	3600 GATES BLVD	PORT ARTHUR	TX	Terminated
DSH450034AS	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS Southeast Texas Spine Center	2965 Harrison St. Suite 111	Beaumont	TX	Active
DSH450034AT	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS Southeast Texas Orthopedic Specialty Center	2927 Park Plaza Lane	Port Arthur	TX	Terminated
DSH450034AU	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS Southeast Texas Outpatient Center St. Mary- Hyperbaric & Wound Care Center	8801 9th Ave	Port Arthur	TX	Active
DSH450034AV	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Pavilion St. Elizabeth – Dermatology Surgery	755 N. 11th Street	Beaumont	TX	Active
DSH450034AW	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Pavillion St. Elizabeth - Plastic and Reconstructive Surgery Center - Surgery	755 N. 11th St.	Beaumont	TX	Active
DSH450034AY	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS Southeast Texas Heart and Vascular - Heart and Vascular - Cardiology	755 N. 11th St.	Beaumont	TX	Active
DSH450034AZ	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS Chemotherapy and Infusion Center	8801 9th Ave	Port Arthur	TX	Active
DSH450034B	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Center for Health Management St. Elizabeth-Heart Failure Clinic	2980 North St.	Beaumont	TX	Terminated
DSH450034BA	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS ORTHOPEDIC	3500 HIGHWAY 365	Port Arthur	TX	Active
DSH450034BB	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS LUNG CARE CENTER - Lung Care	3030 NORTH ST	Beaumont	TX	Terminated
DSH450034BC	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS Southeast Texas Cardiology Center - St. Elizabeth	3030 North St	Beaumont	TX	Active
DSH450034BD	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS Hospital - Outpatient Infusion	2955 Harrison Street	Beaumont	TX	Active
DSH450034BE	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS Trinity Clinic - Rheumatology	3030 North St.	Beaumont	TX	Active
DSH450034BF	Child	DSH	CHRISTUS HOSPITAL	ORANGE - Respiratory Therapy	6901 MEDICAL CENTER DR	ORANGE	TX	Active
DSH450034BG	Child	DSH	CHRISTUS HOSPITAL	ORANGE - ECC Emergency Care	6901 MEDICAL CENTER DR	ORANGE	TX	Active
DSH450034BH	Child	DSH	CHRISTUS HOSPITAL	ORANGE - Cardiology EKG	6901 MEDICAL CENTER DR	ORANGE	TX	Active
DSH450034BJ	Child	DSH	CHRISTUS HOSPITAL	ORANGE - Pharm General	6901 MEDICAL CENTER DR	ORANGE	TX	Active
DSH450034C	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Center for Health Management St. Elizabeth-Cardiac Rehab	2980 North St.	Beaumont	TX	Terminated
DSH450034D	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Emergency Room	3600 GATES BLVD	PORT ARTHUR	TX	Terminated
DSH450034E	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Pavillion St. Elizabeth - Day Surgery	755 N. 11TH ST	Beaumont	TX	Active
DSH450034F	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Pavillion St. Elizabeth - PACU	755 N. 11TH ST	Beaumont	TX	Terminated
DSH450034G	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-ED Fast Track	3600 GATES BLVD	PORT ARTHUR	TX	Terminated
DSH450034H	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Pavillion St. Elizabeth - Pedi OP Day Surgery	755 N. 11TH ST	Beaumont	TX	Terminated
DSH450034J	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Surgery	3600 GATES BLVD	PORT ARTHUR	TX	Terminated
DSH450034K	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Day Surgery	3600 GATES BLVD	PORT ARTHUR	TX	Terminated
DSH450034L	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-PACU recovery	3600 GATES BLVD	PORT ARTHUR	TX	Terminated
DSH450034M	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Cardiac Cath	3600 GATES BLVD	PORT ARTHUR	TX	Terminated
DSH450034N	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary - Lab	8801 9th Avenue	PORT ARTHUR	TX	Active
DSH450034P	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Radiology	3600 GATES BLVD	PORT ARTHUR	TX	Terminated
DSH450034Q	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS Chemotherapy and Infusion Center	2001 9th Ave., Suite 203	PORT ARTHUR	TX	Terminated
DSH450034R	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Endoscopy/G.I.	3600 GATES BLVD	PORT ARTHUR	TX	Terminated
DSH450034S	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Physical Therapy	3600 GATES BLVD	PORT ARTHUR	TX	Terminated
DSH450034T	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Pain Management Center - St. Mary	2001 9TH AVE, STE 300	PORT ARTHUR	TX	Terminated
DSH450034U	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Center St. Mary - Radiology	8801 9th Avenue	PORT ARTHUR	TX	Active
DSH450034V	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Center St. Mary - Physical Medicine	8801 9th Avenue	PORT ARTHUR	TX	Active
DSH450034W	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Pavillion St. Elizabeth - Extended Stay	755 N. 11TH ST.	Beaumont	TX	Terminated
DSH450034X	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Pain Management Center - St. Elizabeth	755 N. 11TH ST.	Beaumont	TX	Active
DSH450034Y	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Center St. Mary-ER	8801 9th Avenue	PORT ARTHUR	TX	Active
DSH450034Z	Child	DSH	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Pavillion St. Elizabeth - Radiology	755 N. 11th St., Suite D1091	BEAUMONT	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Hospital Type Change Request	Trevino, Paul Regional CEO CHRISTUS Hospital 4098997102	Trevino, Paul CEO, CHRISTUS Health Southeast Texas CHRISTUS Hospital 4098997102	7/13/2018 9:43 AM
Contacts	Signed By	Update	Hospital Type Change Request	Trevino, Paul Regional CEO CHRISTUS Hospital 4098997102	Trevino, Paul CEO, CHRISTUS Health Southeast Texas CHRISTUS Hospital 4098997102	7/13/2018 9:43 AM
Contacts	Primary Contact	Update	Hospital Type Change Request	Welch, Tommy Director of Pharmacy 4098997042	Welch, Tommy Director of Pharmacy CHRISTUS Hospital 4098997042	7/13/2018 9:43 AM
Details	State	Update		To Be Terminated	Terminated	1/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		11/28/2017 12:00:00 AM	11/29/2017 9:00 PM
Details	State	Update	Recertification	Active	To Be Terminated	11/29/2017 9:00 PM
Terminations	Termination Date	Update	Recertification		1/1/2018 12:00:00 AM	11/29/2017 9:00 PM
Terminations	Termination Effective Date	Update	Recertification		11/30/2017 12:00:00 AM	11/29/2017 9:00 PM
Terminations	Termination Reason	Update	Recertification		DSH percentage below statutory minimum	11/29/2017 9:00 PM
Contacts	Authorizing Official	Update		Trevino, Paul Regional CEO 4098997102	Trevino, Paul Regional CEO CHRISTUS Hospital 4098997102	10/6/2017 9:36 AM
Contacts	Signed By	Update		Trevino, Paul Regional CEO 4098997102	Trevino, Paul Regional CEO CHRISTUS Hospital 4098997102	10/6/2017 9:36 AM
Contacts	Authorizing Official	Insert			Trevino, Paul Regional CEO 4098997102	8/11/2017 3:29 PM
Contacts	Signed By	Insert			Trevino, Paul Regional CEO 4098997102	8/11/2017 3:29 PM
Contacts	Primary Contact	Insert			Welch, Tommy Director of Pharmacy 4098997042	8/2/2017 2:37 PM
Addresses	Main Address	Insert			3600 GATES BLVD PORT ARTHUR, TX 77642-3858	7/3/2017 12:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/31/2016 10:41 AM
Medicaid Billing	Medicaid: Number	Insert			138296207	8/31/2016 10:41 AM
Medicaid Billing	Medicaid: State	Insert			TX	8/31/2016 10:41 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/31/2016 10:41 AM
Medicaid Billing	Medicaid: Number	Insert			138296206	8/31/2016 10:41 AM
Medicaid Billing	Medicaid: State	Insert			TX	8/31/2016 10:41 AM
Details	Last Recertification Date	Update		8/19/2015 12:00:00 AM	8/30/2016 12:00:00 AM	8/31/2016 10:41 AM
Details	Last Recertification Date	Update			8/19/2015 12:00:00 AM	8/19/2015 10:13 AM
Details	Entity Subname	Update		CHRISTUS HEALTH SOUTHEAST TEXAS / Radiology-Main	CHRISTUS SOUTHEAST TEXAS St. Mary-Radiology	8/19/2015 10:13 AM
Dates	Participating Approval Date	Update			3/12/2015 12:00:00 AM	3/12/2015 1:26 PM
Details	State	Update		Pending	Active	3/12/2015 1:26 PM
Dates	Start Date	Update			4/1/2015 12:00:00 AM	3/12/2015 1:26 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_48984	DSH450034P	1/27/2015 2:55 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_48984	1/13/2015 5:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/13/2015 5:01 PM
Medicaid Billing	Medicaid: Number	Insert			138296208	1/13/2015 5:01 PM
Medicaid Billing	Medicaid: State	Insert			TX	1/13/2015 5:01 PM
Medicaid Billing	NPI: Number	Insert			1679557888	1/13/2015 5:01 PM
Details	Last Recertification Date	Insert				1/13/2015 5:01 PM
Details	Grant Number	Insert				1/13/2015 5:01 PM
Details	340B ID	Insert				1/13/2015 5:01 PM
Details	Is Authorizing Official EHB Data	Insert				1/13/2015 5:01 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/13/2015 5:01 PM
Details	Medicare Provider Number	Insert			450034	1/13/2015 5:01 PM
Details	Entity Name	Insert			CHRISTUS HOSPITAL	1/13/2015 5:01 PM
Details	Program Code	Insert			DSH	1/13/2015 5:01 PM
Details	Entity Subname	Insert			CHRISTUS HEALTH SOUTHEAST TEXAS / Radiology-Main	1/13/2015 5:01 PM
Dates	Participating Approval Date	Insert				1/13/2015 5:01 PM
Details	State	Insert			Pending	1/13/2015 5:01 PM
Dates	Registration Date	Insert			1/13/2015 12:00:00 AM	1/13/2015 5:01 PM
Dates	Signed By Date	Insert			1/13/2015 12:00:00 AM	1/13/2015 5:01 PM
Dates	Start Date	Insert				1/13/2015 5:01 PM
Terminations	Termination Comments	Insert				1/13/2015 5:01 PM
Terminations	Termination Date	Insert				1/13/2015 5:01 PM
Terminations	Termination Effective Date	Insert				1/13/2015 5:01 PM
Terminations	Termination Reason	Insert				1/13/2015 5:01 PM