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CVS PHARMACY, INC.
DSH450034 CHRISTUS HOSPITAL
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Covered Entity Details
Entity Name
CHRISTUS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450034
Entity Address
2830 CALDER STREET
BEAUMONT, TX 77702-1048
Medicare Provider Number
450034
Participating Start Date
5/25/2021
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 06491
1295 N MAIN ST
VIDOR, TX 77662
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/11/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Trevino, CEO, CHRISTUS Health Southeast Texas
(409) 899-7102
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/17/2022
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