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DSH450237CQ SANTA ROSA HEALTHCARE (Active)
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Main Details
Name
SANTA ROSA HEALTHCARE
Subdivision Name
CHRISTUS Santa Rosa Urology Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450237CQ
Medicare Provider Number
450237
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/10/2024
Participating Start Date
4/1/2024
Participating Approval Date
1/18/2024
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
CHRISTUS Santa Rosa
Steve Chen, CFO
(210) 321-8031
Primary Contact
CHRISTUS Santa Rosa Health System
Dustyn Tysdal, REGIONAL DIRECTOR OF PHARMACY
(210) 704-0130
Addresses
Street Address
2833 BABCOCK RD
STE 212
SAN ANTONIO, TX 78229-4894
Billing Address
SANTA ROSA HEALTHCARE
2827 BABCOCK ROAD
SAN ANTONIO, TX 78229
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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