Covered Entity Details

RRC450034-32 CHRISTUS HOSPITAL (Terminated) - information as of 5/5/2025 10:08:57 PM

Main Details

Name

CHRISTUS HOSPITAL

Subdivision Name

CHRISTUS SOUTHEAST TEXAS Bariatric Center St. Elizabeth - Bariatric Center

Type

Rural Referral Center

Rural

340B ID

RRC450034-32

Medicare Provider Number

450034

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/13/2018

Participating Start Date

10/1/2018

Participating Approval Date

8/28/2018

Last Recertification Date

8/31/2020

Termination Date
Termination Reason

5/25/2021
Change of hospital entity type

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

3030 NORTH STREET
SUITE 340
BEAUMONT, TX 77702-1434

Billing Address

CHRISTUS Hospital
2830 Calder Ave
BEAUMONT, TX 77702

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

Shipping Address 1

CHRISTUS Hospital
2830 Calder Ave
BEAUMONT, TX 77702

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
RRC450034-01	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Orthopedic Specialty Center - Physical Therapy - Physical Therapy	3650 LAUREL STREET	BEAUMONT	TX	Terminated
RRC450034-02	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Physical Therapy - Physical Therapy	3600 Gates Blvd	PORT ARTHUR	TX	Terminated
RRC450034-03	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Center St. Mary-Physical Medicine - Physical Medicine	8801 9th Avenue	PORT ARTHUR	TX	Terminated
RRC450034-04	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Orthopedic Specialty Center - Day Surgery - Day Surgery	3650 LAUREL STREET	BEAUMONT	TX	Terminated
RRC450034-05	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Orthopedic Specialty Center Mid County - Orthopaedics	2501 Jimmy Johnson Blvd.	PORT ARTHUR	TX	Terminated
RRC450034-06	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Orthopedic Specialty Center -BBJ Beaumont - Clinic	3650 LAUREL STREET	BEAUMONT	TX	Terminated
RRC450034-07	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Orthopedic Specialty Center - OP Radiology - Radiology	3650 LAUREL STREET	BEAUMONT	TX	Terminated
RRC450034-08	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Radiology - Radiology	3600 Gates Blvd	PORT ARTHUR	TX	Terminated
RRC450034-09	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Pavillion St. Elizabeth - Radiology - Radiology	755 N. 11th St.,	BEAUMONT	TX	Terminated
RRC450034-10	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Center St. Mary-Radiology - Radiology	8801 9th Avenue	PORT ARTHUR	TX	Terminated
RRC450034-11	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Pavillion St. Elizabeth - PACU - PACU	755 N. 11th St.	BEAUMONT	TX	Terminated
RRC450034-12	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-PACU recovery - PACU Recovery	3600 Gates Blvd	PORT ARTHUR	TX	Terminated
RRC450034-13	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Surgery - Surgery	3600 Gates Blvd	PORT ARTHUR	TX	Terminated
RRC450034-14	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Day Surgery - Day Surgery	3600 Gates Blvd	PORT ARTHUR	TX	Terminated
RRC450034-15	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Pavillion St. Elizabeth - Day Surgery - Day Surgery	755 N. 11TH ST	BEAUMONT	TX	Terminated
RRC450034-16	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Cardiac Cath - Cardiac Cath	3600 Gates Blvd	PORT ARTHUR	TX	Terminated
RRC450034-17	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Elizabeth -Cardiac Cath - Cardiac Cath	2830 Calder Ave	BEAUMONT	TX	Terminated
RRC450034-18	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Center St. Mary-ER - Emergency Room	8801 9th Avenue	PORT ARTHUR	TX	Terminated
RRC450034-19	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Emergency Room - ER	3600 Gates Blvd	PORT ARTHUR	TX	Terminated
RRC450034-20	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Elizabeth-Emergency Room - Emergency Room	2830 Calder Ave	BEAUMONT	TX	Terminated
RRC450034-21	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Center St. Mary-Lab - Lab	8801 9th Avenue	PORT ARTHUR	TX	Terminated
RRC450034-22	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Lab - Lab	8801 9th Avenue	PORT ARTHUR	TX	Terminated
RRC450034-23	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Pavillion St. Elizabeth-Hyperbaric and Wound Care Center - Wound Care	755 N. 11th St.,	BEAUMONT	TX	Terminated
RRC450034-24	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Center St. Mary-Hyperbaric & Wound Care Center - Wound Care	8801 9th Avenue	PORT ARTHUR	TX	Terminated
RRC450034-25	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Center St. Mary-Respiratory - Respiratory	8801 9th Avenue	PORT ARTHUR	TX	Terminated
RRC450034-26	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Elizabeth -Respiratory Therapy - Respiratory	2830 Calder Ave	BEAUMONT	TX	Terminated
RRC450034-27	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Respiratory Therapy - Respiratory	3600 Gates Blvd	PORT ARTHUR	TX	Terminated
RRC450034-28	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Elizabeth -Endoscopy/G.I. - Endoscopy	2830 Calder Ave	BEAUMONT	TX	Terminated
RRC450034-29	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-Endoscopy/G.I. - Endoscopy	3600 Gates Blvd	PORT ARTHUR	TX	Terminated
RRC450034-30	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Pavilion St. Elizabeth – Dermatology Surgery	755 N. 11th St.	BEAUMONT	TX	Terminated
RRC450034-31	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Outpatient Pavilion St. Elizabeth—Plastic and Reconstructive Surgery Center	755 N. 11TH ST.	BEAUMONT	TX	Terminated
RRC450034-32	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Bariatric Center St. Elizabeth - Bariatric Center	3030 NORTH STREET	BEAUMONT	TX	Terminated
RRC450034-33	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Center for Health Management St. Mary - Clinic	4640 Ninth Ave,	PORT ARTHUR	TX	Terminated
RRC450034-34	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS Southeast Texas Spine Center - Spine Clinic	2965 Harrison St.	BEAUMONT	TX	Terminated
RRC450034-36	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Center for Health Management St. Elizabeth-Heart Failure Clinic/Cardiac Rehab - Cardiac	2980 North St.	BEAUMONT	TX	Terminated
RRC450034-37	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Pain Management Center - St. Mary - Pain Management	2001 9TH AVE	PORT ARTHUR	TX	Terminated
RRC450034-38	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS Pain Management Center - St. Elizabeth - Pain Management	755 N. 11TH ST.	BEAUMONT	TX	Terminated
RRC450034-39	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS Southeast Texas Heart and Vascular - Heart and Vascular	755 N. 11th St.	BEAUMONT	TX	Terminated
RRC450034-41	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS SOUTHEAST TEXAS St. Mary-ED Fast Track - ER	3600 Gates Blvd	PORT ARTHUR	TX	Terminated
RRC450034-42	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS Chemotherapy and Infusion Center - Chemotherapy	8801 9th Ave	PORT ARTHUR	TX	Terminated
RRC450034-43	Child	RRC	CHRISTUS HOSPITAL	CHRISTUS HEALTH SOUTHEAST TEXAS / Med/Surg - Outpatient Observation Beds - Observation	3600 Gates Blvd.	PORT ARTHUR	TX	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	5/25/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	OPA Edit Termination Info	7/1/2021 12:00:00 AM	5/25/2021 12:00:00 AM	5/21/2021 1:05 PM
Terminations	Termination Date	Update	OPA Edit Termination Info	7/1/2021 12:00:00 AM	5/25/2021 12:00:00 AM	5/21/2021 1:05 PM
Terminations	Termination Effective Date	Update	OPA Edit Termination Info	7/1/2021 12:00:00 AM	5/25/2021 12:00:00 AM	5/21/2021 1:05 PM
Terminations	Termination Reason	Update	OPA Edit Termination Info	Change of covered entity type	Change of hospital entity type	5/21/2021 1:05 PM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		7/1/2021 12:00:00 AM	4/7/2021 1:24 PM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	4/7/2021 1:24 PM
Terminations	Termination Date	Update	Hospital Type Change Request		7/1/2021 12:00:00 AM	4/7/2021 1:24 PM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		7/1/2021 12:00:00 AM	4/7/2021 1:24 PM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	4/7/2021 1:24 PM
Medicaid Billing	NPI: State	Update	Recertification		TX	8/31/2020 4:41 PM
Details	Last Recertification Date	Update	Recertification	9/3/2019 11:52:50 AM	8/31/2020 4:41:39 PM	8/31/2020 4:41 PM
Details	Last Recertification Date	Update	Recertification		9/3/2019 11:52:50 AM	9/3/2019 11:52 AM
Details	State	Update		Approved	Active	10/1/2018 12:05 AM
Contacts	Signed By	Insert	New Registration		Trevino, Paul CEO, CHRISTUS Health Southeast Texas CHRISTUS Hospital 4098997102	8/28/2018 10:04 AM
Details	340B ID	Update	New Registration		RRC450034-32	8/28/2018 10:04 AM
Details	Entity Subname	Update	New Registration	CHRISTUS SOUTHEAST TEXAS Bariatric Center St. Elizabeth	CHRISTUS SOUTHEAST TEXAS Bariatric Center St. Elizabeth - Bariatric Center	8/28/2018 10:04 AM
Dates	Participating Approval Date	Update	New Registration		8/28/2018 10:04:04 AM	8/28/2018 10:04 AM
Details	State	Update	New Registration	Pending	Approved	8/28/2018 10:04 AM
Dates	Signed By Date	Update	New Registration		7/13/2018 12:10:46 PM	8/28/2018 10:04 AM
Dates	Start Date	Update	New Registration		10/1/2018 12:00:00 AM	8/28/2018 10:04 AM
Addresses	Main Address	Insert	New Registration		3030 NORTH STREET SUITE 340 BEAUMONT, TX 77702-1434	7/13/2018 12:10 PM
Addresses	Billing Address	Insert	New Registration		CHRISTUS Hospital 2830 Calder Ave BEAUMONT, TX 77702	7/13/2018 12:10 PM
Addresses	Shipping Address	Insert	New Registration		CHRISTUS Hospital 2830 Calder Ave BEAUMONT, TX 77702	7/13/2018 12:10 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/13/2018 12:10 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		138296208	7/13/2018 12:10 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	7/13/2018 12:10 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/13/2018 12:10 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		138296207	7/13/2018 12:10 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	7/13/2018 12:10 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/13/2018 12:10 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		138296206	7/13/2018 12:10 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	7/13/2018 12:10 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1679557888	7/13/2018 12:10 PM
Contacts	Authorizing Official	Insert	New Registration		Trevino, Paul CEO, CHRISTUS Health Southeast Texas CHRISTUS Hospital 4098997102	7/13/2018 12:10 PM
Contacts	Primary Contact	Insert	New Registration		Welch, Tommy Director of Pharmacy CHRISTUS Hospital 4098997042	7/13/2018 12:10 PM
Details	Last Recertification Date	Insert	New Registration			7/13/2018 12:10 PM
Details	Grant Number	Insert	New Registration			7/13/2018 12:10 PM
Details	340B ID	Insert	New Registration			7/13/2018 12:10 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/13/2018 12:10 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/13/2018 12:10 PM
Details	Medicare Provider Number	Insert	New Registration		450034	7/13/2018 12:10 PM
Details	Entity Name	Insert	New Registration		CHRISTUS HOSPITAL	7/13/2018 12:10 PM
Details	Program Code	Insert	New Registration		RRC	7/13/2018 12:10 PM
Details	Entity Subname	Insert	New Registration		CHRISTUS SOUTHEAST TEXAS Bariatric Center St. Elizabeth	7/13/2018 12:10 PM
Dates	Participating Approval Date	Insert	New Registration			7/13/2018 12:10 PM
Details	State	Insert	New Registration		Pending	7/13/2018 12:10 PM
Dates	Registration Date	Insert	New Registration		7/13/2018 12:10:43 PM	7/13/2018 12:10 PM
Dates	Signed By Date	Insert	New Registration			7/13/2018 12:10 PM
Dates	Start Date	Insert	New Registration			7/13/2018 12:10 PM
Terminations	Termination Comments	Insert	New Registration			7/13/2018 12:10 PM
Terminations	Termination Date	Insert	New Registration			7/13/2018 12:10 PM
Terminations	Termination Effective Date	Insert	New Registration			7/13/2018 12:10 PM
Terminations	Termination Reason	Insert	New Registration			7/13/2018 12:10 PM