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DSH450034Z CHRISTUS HOSPITAL (Active)
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Main Details
Name
CHRISTUS HOSPITAL
Subdivision Name
CHRISTUS SOUTHEAST TEXAS Outpatient Pavillion St. Elizabeth - Radiology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450034Z
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
755 N. 11th St., Suite D1091
BEAUMONT, TX 77702-1501
Billing Address
CHRISTUS Hospital
2830 Calder St.
Beaumont, TX 77702
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (04/01/2015) until terminated effective date: (01/01/2018), reinstatement effective date: (05/25/2021)
05/21/2021
Participating from effective date: (4/1/2015) until terminated effective date: (1/1/2018), reinstatement effective date: (07/01/2021)
04/23/2021
April 2025
April 2025
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