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HEB PHARMACY WAREHOUSE 208
DSH450597 DEWITT MEDICAL DISTRICT DBA CUERO REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
DEWITT MEDICAL DISTRICT DBA CUERO REGIONAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450597
Entity Address
2550 N ESPLANADE ST
CUERO, TX 77954-4736
Medicare Provider Number
450597
Participating Start Date
1/1/2005
Last Recertification Date
8/20/2024
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
7/17/2023
Contract Begin Date
7/17/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alma Alexander, CFO
(361) 275-6191
Contract Pharmacy Representative
Cuero Regional Hospital
William Michael Marshall, Director of Pharmacy
(361) 275-0559
Signed By Date
7/17/2023
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