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DSH450054D SCOTT AND WHITE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
SCOTT AND WHITE MEMORIAL HOSPITAL
Subdivision Name
SCOTT AND WHITE KILLEEN CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450054D
Medicare Provider Number
450054
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/28/2007
Participating Start Date
1/1/2008
Participating Approval Date
11/28/2007
Last Recertification Date
8/15/2018
Termination Date
Termination Reason
7/1/2019
Other
Contacts
Authorizing Official
Baylor Scott & White Medical Center - Temple
Shahin Motakef, CEO
(254) 724-6583
Primary Contact
Scott & White Medical Center - Temple
Sara Rainey, Pharmacy Specialist
(254) 724-2081
Addresses
Street Address
3801 SCOTT AND WHITE DRIVE
KILLEEN, TX 76543
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/26/08- DOC RECD TO CONFIRM ELIG DSH ADJ %
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