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HEB PHARMACY #401
DSH450046 CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE
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Covered Entity Details
Entity Name
CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450046
Entity Address
600 Elizabeth St.
CORPUS CHRISTI, TX 78404
Medicare Provider Number
450046
Participating Start Date
4/1/1997
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
HEB PHARMACY #401
Pharmacy Address
409 E. KLEBERG
KINGSVILLE, TX 78363
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
2/3/2025
Business decision by covered entity and/or pharmacy
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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