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DSH450395 Memorial Medical Center-Livingston (Active)
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Main Details
Name
Memorial Medical Center-Livingston
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450395
Medicare Provider Number
450395
Additional Details
Current Program Status
Active
Registration Date
12/1/2011
Participating Start Date
1/1/2012
Participating Approval Date
12/15/2011
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
CHI ST Luke's Health Memorial Livingston
Kristina Froese, VP of Operations
(936) 329-8726
Primary Contact
St. Joseph Regional Health Center
Kimberly Feese, Market Director Pharmacy
(979) 776-2506
Addresses
Street Address
1717 Hwy 59 Bypass
Livingston, TX 77351
Billing Address
Memorial Medical Center-Livingston
PO Box 2400
Phoenix, AZ 85002
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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