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DSH450235 GONZALES HEALTHCARE SYSTEMS (Terminated)
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Main Details
Name
GONZALES HEALTHCARE SYSTEMS
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450235
Medicare Provider Number
450235
Additional Details
Current Program Status
Terminated
Registration Date
7/7/2008
Participating Start Date
10/1/2004
Participating Approval Date
7/7/2008
Last Recertification Date
9/2/2019
Termination Date
Termination Reason
5/6/2020
DSH percentage below statutory minimum
Contacts
Authorizing Official
Gonzales Healthcare Systems
Patty Stewart, Interim CEO
(830) 519-9101
Primary Contact
Gonzales Healthcare Systems
Adolph Novosad III, Pharmacist In Charge - Director of Pharmacy
(830) 672-7581 Ext: 1501
Addresses
Street Address
1110 N SARAH DEWITT DRIVE
GONZALES, TX 78629
Billing Address
Gonzales Healthcare Systems
P.O. Box 587
Gonzales, TX 78629
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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10/26/04 UPDATED ADDR (WAS 1120 SARAH DEWITT DRIVE)
01/12/2010
May 2025
May 2025
week
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27
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30
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19
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23
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7
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Custom
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