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DSH450054S SCOTT AND WHITE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
SCOTT AND WHITE MEMORIAL HOSPITAL
Subdivision Name
TEMPLE TOWNE CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450054S
Medicare Provider Number
450054
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/15/2010
Participating Start Date
10/1/2010
Participating Approval Date
9/16/2010
Last Recertification Date
8/17/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Baylor Scott & White Medical Center - Temple
Shahin Motakef, CEO
(254) 724-6583
Primary Contact
Emory S. Martin III, VP - Pharmacy Services
(254) 724-3811
Addresses
Street Address
2112 LOOP 363
SUITE 110
TEMPLE, TX 76502
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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09/27/10-UPDATED ADDR.(WAS 212 LOOP 363 SUITE 110)
09/15/2010
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