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HEB PHARMACY WAREHOUSE 208
DSH450844 HOUSTON METHODIST WILLOWBROOK HOSPITAL
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Covered Entity Details
Entity Name
HOUSTON METHODIST WILLOWBROOK HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450844
Entity Address
18220 STATE HIGHWAY 249
HOUSTON, TX 77070-4347
Medicare Provider Number
450844
Participating Start Date
4/1/2018
Last Recertification Date
8/15/2024
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
7/27/2023
Contract Begin Date
7/27/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Julie K Peterson, Vice President/Chief Operating Officer
(281) 737-2115
Contract Pharmacy Representative
HEB
Kimberly Lavrack, Director of Third Party
(210) 938-7344
Signed By Date
7/27/2023
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