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HEALTHCARE CENTER PHARMACY
DSH320002 ST. VINCENT HOSPITAL
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Covered Entity Details
Entity Name
ST. VINCENT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320002
Entity Address
455 ST. MICHAELS DRIVE
SANTA FE, NM 87505
Medicare Provider Number
320002
Participating Start Date
1/1/2014
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
HEALTHCARE CENTER PHARMACY
Pharmacy Address
2604 ST MICHAEL DRIVE, SUITE 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
4/10/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Patrick B. Carrier, President & CEO
(505) 913-5202
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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