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CAH451356-00 MEMORIAL MEDICAL CENTER (Active)
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Main Details
Name
MEMORIAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH451356-00
Medicare Provider Number
451356
Additional Details
Current Program Status
Active
Registration Date
9/13/2010
Participating Start Date
9/16/2010
Participating Approval Date
9/14/2010
Last Recertification Date
9/8/2024
Contacts
Authorizing Official
Memorial Medical Center
Steve Brock, Chief Financial Officer
(361) 552-6713 Ext: 291
Primary Contact
Memorial Medical Center
Andrew De Los Santos, Controller
(361) 552-6713 Ext: 288
Addresses
Street Address
815 N VIRGINIA STREET
PORT LAVACA, TX 77979
Billing Address
MEMORIAL MEDICAL CENTER
PO BOX 25
PORT LAVACA, TX 77979
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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