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DSH450034AZ CHRISTUS HOSPITAL (Active)
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Main Details
Name
CHRISTUS HOSPITAL
Subdivision Name
CHRISTUS Chemotherapy and Infusion Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450034AZ
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
8801 9th Ave
Port Arthur, TX 77642
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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