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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 SPECIALTY PHARMACY #15320
4101 GREENBRIAR DR STE 235
HOUSTON, TX 77098
Pharmacy Comments
Contract Details
Approval Date
4/8/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patrick Shannon, Chief Operating Officer
(409) 212-5005
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/8/2016
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