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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 10231
1055 E MAIN ST
ALICE, TX 78332-5044
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
2/21/2017
Business decision by covered entity and/or pharmacy
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
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