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WALGREEN CO.
DSH450346 BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL
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Covered Entity Details
Entity Name
BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450346
Entity Address
3080 COLLEGE STREET
BEAUMONT, TX 77701
Medicare Provider Number
450346
Participating Start Date
7/1/2004
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 10139
1305 N MAIN ST
VIDOR, TX 77662
Pharmacy Comments
Contract Details
Approval Date
10/18/2011
Contract Begin Date
10/18/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Parmer, CEO
(409) 212-5012
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/18/2011
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