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AMERITA, INC.
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
AMERITA, INC.
Pharmacy Address
6015 RANDOLPH BLVD
SAN ANTONIO, TX 78233-5719
Pharmacy Comments
Contract Details
Approval Date
7/9/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Becky Rios, CFO
(361) 881-3157
Contract Pharmacy Representative
Amerita, Inc.
Dan Van Valkenburg, Director, 340B Program
(810) 434-2710
Signed By Date
7/9/2019
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