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CAH451371-03 SETON EDGAR B. DAVIS HOSPITAL (Terminated)
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Main Details
Name
SETON EDGAR B. DAVIS HOSPITAL
Subdivision Name
SETON EDGAR B. DAVIS HOSPITAL OUTPATIENT LAB AND IMAGING
Type
Critical Access Hospital
Rural
No
340B ID
CAH451371-03
Medicare Provider Number
451371
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/19/2010
Participating Start Date
8/19/2010
Participating Approval Date
8/19/2010
Last Recertification Date
8/18/2016
Termination Date
Termination Reason
4/1/2017
Loss of qualifying grant/support
Contacts
Authorizing Official
Seton Edgar B. Davis Hospital
Apryl Renee Haynes, COO/CNO
(830) 875-7041
Primary Contact
Seton Healthcare Family
Shewan M. Aziz, Senior Network Director of Pharmacy
(512) 324-7303
Addresses
Street Address
300 S. COLORADO
SUITE C1
LOCKHART, TX 78644-2162
Billing Address
SETON EDGAR B. DAVIS HOSPITAL
P.O. BOX 33034
SAN ANTONIO, TX 78265-3034
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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