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WAL-MART PHARMACY 10-0791
DSH450828 CHRISTUS SPOHN HOSPITAL ALICE
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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
WAL-MART PHARMACY 10-0791
Pharmacy Address
2701 E. MAIN
ALICE, TX 78332
Pharmacy Comments
Contract Details
Approval Date
4/6/2012
Contract Begin Date
4/6/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/3/2025
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
Wal--Mart
Marcus Osborne, Sales & Contracting
(479) 204-8452
Signed By Date
3/30/2012
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