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DSH450054AH SCOTT AND WHITE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
SCOTT AND WHITE MEMORIAL HOSPITAL
Subdivision Name
SCOTT AND WHITE HARKER HEIGHTS EYE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450054AH
Medicare Provider Number
450054
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/19/2012
Participating Start Date
4/1/2012
Participating Approval Date
3/30/2012
Last Recertification Date
8/17/2015
Termination Date
Termination Reason
10/1/2015
Loss of qualifying grant/support
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
201 East Central Texas Expressway
HARKER HEIGHTS, TX 76548
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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