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DSH450039H TARRANT COUNTY HOSPITAL DISTRICT, JOHN PETER SMITH HOSPITAL (Terminated)
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Main Details
Name
TARRANT COUNTY HOSPITAL DISTRICT, JOHN PETER SMITH HOSPITAL
Subdivision Name
JPS OUTPATIENT CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450039H
Medicare Provider Number
450039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2008
Participating Start Date
10/1/2001
Participating Approval Date
7/10/2008
Last Recertification Date
12/1/2017
Termination Date
Termination Reason
10/1/2018
Other
Contacts
Authorizing Official
JPS Health Network
Sharon R Clark, Senior Executive Vice President, CFO
(817) 702-6833
Primary Contact
Tarrant County Hospital District d/b/a/ JPS Health Network
Nicole Shoquist, Chief Pharmacy Officer
(806) 674-2644
Addresses
Street Address
1500 SOUTH MAIN ST, STE OPC-1
FORT WORTH, TX 76104
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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9/18/08-REVISED SUBDIV NAME (WAS JPS OUTPATIENT PHARMACY); ADDED MEDICAID #145241
09/18/2008
May 2025
May 2025
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