Covered Entity Details

DSH450034AZ CHRISTUS HOSPITAL (Active) - information as of 5/3/2025 11:31:31 PM

Main Details

Name

CHRISTUS HOSPITAL

Subdivision Name

CHRISTUS Chemotherapy and Infusion Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH450034AZ

Medicare Provider Number

450034

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/6/2021

Participating Start Date

5/25/2021

Participating Approval Date

4/23/2021

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

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

Primary Contact

CHRISTUS Health
Santosh Kalathra, Director of Pharmacy
(409) 236-7042

Addresses

Street Address

8801 9th Ave
Port Arthur, TX 77642

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
LA	1732320	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
Details	Last Recertification Date	Update	Recertification	9/7/2023 6:52:51 AM	8/23/2024 2:55:33 PM	8/23/2024 2:55 PM
Contacts	Primary Contact	Update	Profile Change Request	Kalathra, Santosh Clinical/Operations Pharmacy Supervisor CHRISTUS Health 4098997042	Kalathra, Santosh Director of Pharmacy CHRISTUS Health 4092367042	8/20/2024 10:30 AM
Details	Last Recertification Date	Update	Recertification	9/1/2022 10:23:45 AM	9/7/2023 6:52:51 AM	9/7/2023 6:52 AM
Details	Entity Subname	Update	Recertification	CHRISTUS Chemotherapy and Infusion Center - Chemotherapy - Chemotherapy	CHRISTUS Chemotherapy and Infusion Center	9/7/2023 6:52 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1679557888	1/5/2023 4:56 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	1/5/2023 4:56 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 11:32:46 AM	9/1/2022 10:23:45 AM	9/1/2022 10:23 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	5/20/2022 12:28 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1732320	5/20/2022 12:28 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		LA	5/20/2022 12:28 PM
Details	Last Recertification Date	Update	Recertification		8/16/2021 11:32:46 AM	8/16/2021 11:32 AM
Details	State	Update		Approved	Active	5/25/2021 12:01 AM
Dates	Start Date	Update	OPA Edit	7/1/2021 12:00:00 AM	5/25/2021 12:00:00 AM	5/21/2021 12:53 PM
Contacts	Primary Contact	Update	Change Request	Welch, Tommy Director of Pharmacy CHRISTUS Hospital 4098997042	Kalathra, Santosh Clinical/Operations Pharmacy Supervisor CHRISTUS Health 4098997042	5/4/2021 9:31 AM
Contacts	Signed By	Insert	New Registration		Trevino, Paul CEO, CHRISTUS Health Southeast Texas CHRISTUS Hospital 4098997102	4/23/2021 11:14 AM
Details	340B ID	Update	New Registration		DSH450034AZ	4/23/2021 11:14 AM
Details	Entity Subname	Update	New Registration	CHRISTUS Chemotherapy and Infusion Center - Chemotherapy	CHRISTUS Chemotherapy and Infusion Center - Chemotherapy - Chemotherapy	4/23/2021 11:14 AM
Dates	Participating Approval Date	Update	New Registration		4/23/2021 11:14:47 AM	4/23/2021 11:14 AM
Details	State	Update	New Registration	Pending	Approved	4/23/2021 11:14 AM
Dates	Signed By Date	Update	New Registration		4/12/2021 12:48:14 PM	4/23/2021 11:14 AM
Dates	Start Date	Update	New Registration		7/1/2021 12:00:00 AM	4/23/2021 11:14 AM
Addresses	Main Address	Insert	New Registration		8801 9th Ave Port Arthur, TX 77642	4/6/2021 3:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/6/2021 3:38 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		138296208	4/6/2021 3:38 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	4/6/2021 3:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/6/2021 3:38 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		138296207	4/6/2021 3:38 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	4/6/2021 3:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/6/2021 3:38 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		138296206	4/6/2021 3:38 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	4/6/2021 3:38 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1679557888	4/6/2021 3:38 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	4/6/2021 3:38 PM
Contacts	Authorizing Official	Insert	New Registration		Trevino, Paul CEO, CHRISTUS Health Southeast Texas CHRISTUS Hospital 4098997102	4/6/2021 3:38 PM
Contacts	Primary Contact	Insert	New Registration		Welch, Tommy Director of Pharmacy CHRISTUS Hospital 4098997042	4/6/2021 3:38 PM
Details	Assistance Received From Date	Insert	New Registration			4/6/2021 3:38 PM
Details	Assistance Received To Date	Insert	New Registration			4/6/2021 3:38 PM
Details	Last Recertification Date	Insert	New Registration			4/6/2021 3:38 PM
Details	Grant Number	Insert	New Registration			4/6/2021 3:38 PM
Details	340B ID	Insert	New Registration			4/6/2021 3:38 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/6/2021 3:38 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/6/2021 3:38 PM
Details	Medicare Provider Number	Insert	New Registration		450034	4/6/2021 3:38 PM
Details	Entity Name	Insert	New Registration		CHRISTUS HOSPITAL	4/6/2021 3:38 PM
Details	NOFO Number	Insert	New Registration			4/6/2021 3:38 PM
Details	Program Code	Insert	New Registration		DSH	4/6/2021 3:38 PM
Details	Entity Subname	Insert	New Registration		CHRISTUS Chemotherapy and Infusion Center - Chemotherapy	4/6/2021 3:38 PM
Dates	Participating Approval Date	Insert	New Registration			4/6/2021 3:38 PM
Details	State	Insert	New Registration		Pending	4/6/2021 3:38 PM
Dates	Registration Date	Insert	New Registration		4/6/2021 3:38:19 PM	4/6/2021 3:38 PM
Dates	Signed By Date	Insert	New Registration			4/6/2021 3:38 PM
Dates	Start Date	Insert	New Registration			4/6/2021 3:38 PM
Terminations	Termination Comments	Insert	New Registration			4/6/2021 3:38 PM
Terminations	Termination Date	Insert	New Registration			4/6/2021 3:38 PM
Terminations	Termination Effective Date	Insert	New Registration			4/6/2021 3:38 PM
Terminations	Termination Reason	Insert	New Registration			4/6/2021 3:38 PM