Contract Pharmacy Details

WALGREEN CO.
DSH450163 CHRISTUS SPOHN HOSPITAL KLEBERG

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

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03917
922 E KING AVE
KINGSVILLE, TX 78363

Pharmacy Comments

Contract Details

Approval Date

7/11/2013

Contract Begin Date

10/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/19/2017
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Pamela L. Brower, Chief Finance Officer
(361) 881-3432

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/11/2013

340B Drug Pricing Program Database