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HEB PHARMACY WAREHOUSE 208
DSH450132 MEDICAL CENTER HOSPITAL
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Covered Entity Details
Entity Name
MEDICAL CENTER HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450132
Entity Address
500 WEST 4TH ST.
ODESSA, TX 79761-5001
Medicare Provider Number
450132
Participating Start Date
4/1/1998
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
HEB PHARMACY WAREHOUSE 208
Pharmacy Address
H-E-B, LP
5311 DIETRICH RD STE 100
SAN ANTONIO, TX 78219
Pharmacy Comments
Contract Details
Approval Date
6/29/2023
Contract Begin Date
6/30/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matt D Collins, Vice President of Operations
(432) 640-2445
Contract Pharmacy Representative
HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578
Signed By Date
6/29/2023
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