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HEALTHCARE CENTER PHARMACY
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
HEALTHCARE CENTER PHARMACY
Pharmacy Address
2604 SAINT MICHAEL DR STE 200
TEXARKANA, TX 75503
Pharmacy Comments
Contract Details
Approval Date
1/15/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Nikki Martin, Regional Director, Finance
(409) 899-7105
Contract Pharmacy Representative
CHRISTUS St. Michael Health System
Helen Pennington, Pharmacist in Charge
(903) 614-2215
Signed By Date
1/15/2016
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