Contract Pharmacy Details

WALGREEN CO.
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

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 10231
1055 E MAIN ST
ALICE, TX 78332-5044

Pharmacy Comments

Contract Details

Approval Date

7/10/2013

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

7/10/2013

340B Drug Pricing Program Database