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HEB PHARMACY #223
DSH450828 CHRISTUS SPOHN HOSPITAL ALICE
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Covered Entity Details
Entity Name
CHRISTUS SPOHN HOSPITAL ALICE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450828
Entity Address
2500 EAST MAIN ST.
ALICE, TX 78332
Medicare Provider Number
450828
Participating Start Date
9/16/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
HEB PHARMACY #223
Pharmacy Address
1115 E. MAIN STREET
ALICE, TX 78332
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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