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HEB PHARMACY #418
DSH450154 Val Verde Regional Medical Center
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Covered Entity Details
Entity Name
Val Verde Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450154
Entity Address
801 Bedell Avenue
Del Rio, TX 78840
Medicare Provider Number
450154
Participating Start Date
1/1/2012
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
HEB PHARMACY #418
Pharmacy Address
200 VETERANS BLVD
DEL RIO, TX 78840
Pharmacy Comments
Contract Details
Approval Date
3/14/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
THOMAS GRIMERT, CFO
(830) 778-3610
Contract Pharmacy Representative
HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578
Signed By Date
1/29/2013
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