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DSH450037 GOOD SHEPHERD MEDICAL CENTER (Terminated)
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Main Details
Name
GOOD SHEPHERD MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450037
Medicare Provider Number
450037
Additional Details
Current Program Status
Terminated
Registration Date
6/7/2010
Participating Start Date
7/1/2010
Participating Approval Date
6/14/2010
Last Recertification Date
8/29/2018
Termination Date
Termination Reason
7/1/2019
Other
Contacts
Authorizing Official
Christus Good Shepherd Medical Center
Jason Adams, COO
(903) 315-2440
Primary Contact
Christus Good Shepherd Medical Center
Jonathan Taylor Brown, Director
(903) 315-2019
Addresses
Street Address
700 E. MARSHALL AVENUE
LONGVIEW, TX 75601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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9/17/14 - Corrected typo in period of ineligibility. 4/10/12 REMOVED MEDICAID # (WAS 0940959-02); REINSTATED ORIG PART 4/1/05 - 9/30/05, NOT ELIGIBLE 10/1/05 - 6/30/10-DOC RECD TO CONFIRM ELIG DSH ADJ%; TERMINATED OLD ID DSH75601;
09/17/2014
4/10/12 REMOVED MEDICAID # (WAS 0940959-02); REINSTATED ORIG PART 4/1/05 - 9/30/10, NOT ELIGIBLE 10/1/05 - 6/30/10-DOC RECD TO CONFIRM ELIG DSH ADJ%; TERMINATED OLD ID DSH75601;
04/10/2012
REINSTATED ORIG PART 4/1/05 - 9/30/10, NOT ELIGIBLE 10/1/05 - 6/30/10-DOC RECD TO CONFIRM ELIG DSH ADJ%; TERMINATED OLD ID DSH75601;
06/15/2010
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