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DSH450054X SCOTT AND WHITE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
SCOTT AND WHITE MEMORIAL HOSPITAL
Subdivision Name
WACO
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450054X
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
8/15/2018
Termination Date
Termination Reason
7/1/2019
Other
Contacts
Authorizing Official
Baylor Scott & White Medical Center - Temple
Shahin Motakef, CEO
(254) 724-6583
Primary Contact
Scott & White Medical Center - Temple
Sara Rainey, Pharmacy Specialist
(254) 724-2081
Addresses
Street Address
7700 FISHPOND ROAD
WACO, TX 76710
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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