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HEB PHARMACY #589
RRC450034-00 CHRISTUS HOSPITAL
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Covered Entity Details
Entity Name
CHRISTUS HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC450034-00
Entity Address
2830 CALDER STREET
BEAUMONT, TX 77702-1048
Medicare Provider Number
450034
Participating Start Date
10/1/2018
Last Recertification Date
8/31/2020
Entity Termination Date
5/25/2021
Pharmacy Details
Pharmacy Name
HEB PHARMACY #589
Pharmacy Address
4800 HWY 365
PORT ARTHUR, TX 77642
Pharmacy Comments
Contract Details
Approval Date
4/9/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/25/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Paul Trevino, CEO, CHRISTUS Health Southeast Texas
(409) 899-7102
Contract Pharmacy Representative
HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578
Signed By Date
4/9/2019
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