340B Drug Pricing Program Database
CHRISTUS SPECIALTY PHARMACY
DSH190201 CHRISTUS Lake Area Hospital - information as of 5/10/2025 11:59:00 PM
Covered Entity Details
Entity Name
CHRISTUS Lake Area Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190201
Entity Address
4200 NELSON RD
LAKE CHARLES, LA 70605
Medicare Provider Number
190201
Participating Start Date
1/1/2018
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
CHRISTUS SPECIALTY PHARMACY
Pharmacy Address
MOTHER FRANCES REGIONAL HEALTH CARE CTR
800 E DAWSON ST STE 100
TYLER, TX 75701-2036
Pharmacy Comments
Contract Details
Approval Date
6/4/2021
Contract Begin Date
6/4/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Trevino, CEO, CHRISTUS Health Southeast Texas
(409) 899-7102
Contract Pharmacy Representative
CHRISTUS Health
Justin Simon, Corporate Director of Pharmacy - Business Services
(214) 704-9531
Signed By Date
6/4/2021
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