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CVS PHARMACY, INC.
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
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 00656
1000 E KING AVE
KINGSVILLE, TX 78363
Pharmacy Comments
Contract Details
Approval Date
1/22/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/18/2024
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
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/22/2016
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