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WALGREEN CO.
DSH450346 BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL
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Covered Entity Details
Entity Name
BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450346
Entity Address
3080 COLLEGE STREET
BEAUMONT, TX 77701
Medicare Provider Number
450346
Participating Start Date
7/1/2004
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03958
4930 GULFWAY DR
PORT ARTHUR, TX 77642
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patrick Shannon, Chief Operating Officer
(409) 212-5005
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2019
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