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CVS PHARMACY, INC.
DSH450046 CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE
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Covered Entity Details
Entity Name
CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450046
Entity Address
600 Elizabeth St.
CORPUS CHRISTI, TX 78404
Medicare Provider Number
450046
Participating Start Date
4/1/1997
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 06989
4102 AYERS ST
CORPUS CHRISTI, TX 78415
Pharmacy Comments
Contract Details
Approval Date
7/11/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/25/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Pamela L. Brower, Chief Finance Officer
(361) 881-3432
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
7/11/2013
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