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DSH450571X SHANNON MEDICAL CENTER (Active)
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Main Details
Name
SHANNON MEDICAL CENTER
Subdivision Name
SHANNON MEDICATION THERAPY MANAGEMENT 7072 - Medication Therapy Management
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450571X
Medicare Provider Number
450571
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/10/2024
Participating Start Date
10/1/2024
Participating Approval Date
7/18/2024
Last Recertification Date
Contacts
Authorizing Official
Shannon Medical Center
Joseph Wooldridge, Chief Financial Officer
(325) 657-5303
Primary Contact
Shannon Medical Center
Stephanie McCann, Pharmacy Director
(325) 747-5287
Addresses
Street Address
122 South Oakes STE 101
San Angelo, TX 76903
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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