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DSH450132 MEDICAL CENTER HOSPITAL (Active)
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Main Details
Name
MEDICAL CENTER HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450132
Medicare Provider Number
450132
Additional Details
Current Program Status
Active
Registration Date
1/3/2008
Participating Start Date
4/1/1998
Participating Approval Date
1/3/2008
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Medical Center Hospital
Matt D Collins, Vice President of Operations
(432) 640-2445
Primary Contact
Medical Center Hospital
Yaze Li, Assistant Director of Pharmacy
(432) 640-2604
Addresses
Street Address
500 WEST 4TH ST.
ODESSA, TX 79761-5001
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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5/23/12 Parent site was listed as pharmacy and child sites was parent. Reversal made and child site terminated with parent site reinstated to prevent loss of 340B eligibility JH 12/23/11 ADDED NPI #
05/23/2012
12/23/11 ADDED NPI #
12/23/2011
June 2025
June 2025
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