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DSH450237 SANTA ROSA HEALTHCARE (Active)
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Main Details
Name
SANTA ROSA HEALTHCARE
Subdivision Name
CHRISTUS SANTA ROSA HOSPITAL MEDICAL CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450237
Medicare Provider Number
450237
Additional Details
Current Program Status
Active
Registration Date
4/13/2023
Participating Start Date
7/1/2023
Participating Approval Date
4/20/2023
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
2827 BABCOCK ROAD
SAN ANTONIO, TX 78229
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (07/1/2006) until terminated effective date: (01/1/2017), reinstatement effective date: (07/1/2023)
04/20/2023
1/30/12 UPDATED ENTITY NAME (WAS CHRISTUS SANTA ROSA HEALTHCARE); 6/4/2009- CORRECTED MEDICAID NUMBER (WAS LISTED AS 450237)
01/30/2012
6/4/2009- CORRECTED MEDICAID NUMBER (WAS LISTED AS 450237)
06/04/2009
April 2025
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