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WALGREENS MAIL SERVICE, INC.
DSH450573 CHRISTUS JASPER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CHRISTUS JASPER MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450573
Entity Address
1275 MARVIN HANCOCK DRIVE
JASPER, TX 75951
Medicare Provider Number
450573
Participating Start Date
10/1/2004
Last Recertification Date
8/15/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
WALGREENS MAIL SERVICE, INC.
Pharmacy Address
8350 S RIVER PARKWAY
TEMPE, AZ 85284
Pharmacy Comments
Contract Details
Approval Date
10/15/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/5/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Libby Cousins, Assistant Adminstrator of Finance
(409) 384-1867
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2013
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