Contract Pharmacy Details

HEB PHARMACY #223
DSH450828 CHRISTUS SPOHN HOSPITAL ALICE

Covered Entity Details

Entity Name

CHRISTUS SPOHN HOSPITAL ALICE

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH450828

Entity Address

2500 EAST MAIN ST.
ALICE, TX 78332

Medicare Provider Number

450828

Participating Start Date

9/16/2005

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

HEB PHARMACY #223

Pharmacy Address

1115 E. MAIN STREET
ALICE, TX 78332

Pharmacy Comments

Contract Details

Approval Date

1/5/2012

Contract Begin Date

1/5/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/9/2019
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

HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578

Signed By Date

12/27/2011

340B Drug Pricing Program Database