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DSH450237CR SANTA ROSA HEALTHCARE (ToBeTerminated)
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Main Details
Name
SANTA ROSA HEALTHCARE
Subdivision Name
CHRISTUS SANTA ROSA HEART & VASCULA - Heart and Vascular Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450237CR
Medicare Provider Number
450237
Outpatient Facility Provider Number
Additional Details
Current Program Status
ToBeTerminated
Registration Date
7/8/2024
Participating Start Date
10/1/2024
Participating Approval Date
8/6/2024
Last Recertification Date
Termination Date
Termination Reason
7/1/2025
Business decision by the Covered Entity
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
479 OXFORD DR
STE 104
NEW BRAUNFELS, TX 78130-7423
Billing Address
CHRISTUS SANTA ROSA HEALTH SYSTEM
2827 BABCOCK ROAD
SAN ANTONIO, TX 78229
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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