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HEB PHARMACY #401
DSH450163 CHRISTUS SPOHN HOSPITAL KLEBERG
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Covered Entity Details
Entity Name
CHRISTUS SPOHN HOSPITAL KLEBERG
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450163
Entity Address
1311 E. GENERAL CAVAZOS BLVD
KINGSVILLE, TX 78363
Medicare Provider Number
450163
Participating Start Date
9/9/2005
Last Recertification Date
8/20/2024
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
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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