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Walgreens #21373
DSH450034 CHRISTUS HOSPITAL
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Covered Entity Details
Entity Name
CHRISTUS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450034
Entity Address
2830 CALDER STREET
BEAUMONT, TX 77702-1048
Medicare Provider Number
450034
Participating Start Date
5/25/2021
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
Walgreens #21373
Pharmacy Address
Walgreens Central Fill #21373
4100 Dale Earnhardt Way
STE 200
Northlake, TX 76262
Pharmacy Comments
Contract Details
Approval Date
10/13/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Trevino, CEO, CHRISTUS Health Southeast Texas
(409) 899-7102
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/13/2021
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