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DSH450723 METHODIST CHARLTON MEDICAL CENTER (Active)
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Main Details
Name
METHODIST CHARLTON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450723
Medicare Provider Number
450723
Additional Details
Current Program Status
Active
Registration Date
7/1/2005
Participating Start Date
7/1/2005
Participating Approval Date
6/2/2005
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Methodist Health System
Jon T Albrecht, Corporate VP, Chief Pharmacy Officer
(214) 947-2504
Primary Contact
Methodist Charlton Medical Center
JEENA JACOB, DIRECTOR OF PHARMACY SERVICES
(214) 947-7581
Addresses
Street Address
3500 WEST WHEATLAND ROAD
DALLAS, TX 75237-3460
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/25/2010- DOC. RECD. TO CONFIRM ELIG. DSH PERCENTAGE; 5/07- DSH ADJ % >11.75
06/25/2010
May 2025
May 2025
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