340B Drug Pricing Program Database
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DSH450573D CHRISTUS JASPER MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
CHRISTUS JASPER MEMORIAL HOSPITAL
Subdivision Name
Jasper Memorial Outpatient Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450573D
Medicare Provider Number
450573
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/17/2012
Participating Start Date
10/1/2012
Participating Approval Date
8/31/2012
Last Recertification Date
9/10/2019
Termination Date
Termination Reason
4/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
CHRISTUS
Nikki Martin, Regional Director, Finance
(409) 899-7105
Primary Contact
Christus Jaspeer Memorial
Kirk Vital, Director Of Pharmacy
(409) 381-5616
Addresses
Street Address
2014 South Wheeler, Suite 170
Jasper, TX 75951
Billing Address
CHRISTUS Jasper Memorial Hospital
1275 Marvin Hancock Drive
Jasper, TX 75951
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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