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HEB PHARMACY #488
DSH450082 CHRISTUS SPOHN HOSPITAL BEEVILLE
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Covered Entity Details
Entity Name
CHRISTUS SPOHN HOSPITAL BEEVILLE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450082
Entity Address
1500 E. HOUSTON
BEEVILLE, TX 78102
Medicare Provider Number
450082
Participating Start Date
12/16/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
HEB PHARMACY #488
Pharmacy Address
1600 WILDCAT DR
PORTLAND, TX 78374
Pharmacy Comments
Contract Details
Approval Date
4/9/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Becky Rios, Interim CFO
(361) 881-3157
Contract Pharmacy Representative
HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578
Signed By Date
4/9/2019
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