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DSH450034AV CHRISTUS HOSPITAL (Active)
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Main Details
Name
CHRISTUS HOSPITAL
Subdivision Name
CHRISTUS SOUTHEAST TEXAS Outpatient Pavilion St. Elizabeth – Dermatology Surgery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450034AV
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 Street
Suite D2051
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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