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DSH450102BN CHRISTUS MOTHER FRANCES HOSP-TYLER (Active)
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Main Details
Name
CHRISTUS MOTHER FRANCES HOSP-TYLER
Subdivision Name
CHRISTUS TRINITY MOTHER FRANCES NORTHPARK MEDICAL PLAZA - Infusion Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450102BN
Medicare Provider Number
450102
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/16/2024
Participating Start Date
4/1/2024
Participating Approval Date
1/30/2024
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
CHRISTUS Mother Frances Health System
Eric Garrison, CFO
(903) 606-4102
Primary Contact
Christus Mother Frances, Jacksonville
Joshua Ward, 340B Coordinator
(903) 606-7591
Addresses
Street Address
910 E. HOUSTON ST
STE 300
TYLER, TX 75702
Billing Address
CHRISTUS MOTHER FRANCES HOSP-TYLER
800 EAST DAWSON
TYLER, TX 75701
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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