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RRC450034-19 CHRISTUS HOSPITAL (Terminated)
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Main Details
Name
CHRISTUS HOSPITAL
Subdivision Name
CHRISTUS SOUTHEAST TEXAS St. Mary-Emergency Room - ER
Type
Rural Referral Center
Rural
No
340B ID
RRC450034-19
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
8/29/2018
Last Recertification Date
9/3/2019
Termination Date
Termination Reason
10/1/2020
Site closure
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
3600 Gates Blvd
PORT ARTHUR, TX 77642
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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