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HEB PHARMACY #013
SCH450654-00 STARR COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
STARR COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450654-00
Entity Address
128 N FM 3167
RIO GRANDE CITY, TX 78582-6211
Medicare Provider Number
450654
Participating Start Date
1/1/2018
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
HEB PHARMACY #013
Pharmacy Address
4031 EAST US HWY 83
RIO GRANDE CITY, TX 78582
Pharmacy Comments
Contract Details
Approval Date
1/11/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eloy Garza, Assistant Administrator
(956) 487-9055
Contract Pharmacy Representative
HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578
Signed By Date
1/11/2018
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