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HEB PHARMACY WAREHOUSE 208
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
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
7/14/2023
Contract Begin Date
7/14/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Becky Rios, Interim CFO
(361) 881-3157
Contract Pharmacy Representative
HEB
Kimberly Lavrack, Director of Third Party
(210) 938-7344
Signed By Date
7/14/2023
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