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DSH450237E CHRISTUS SANTA ROSA HEALTH SYSTEM (Terminated)
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Main Details
Name
CHRISTUS SANTA ROSA HEALTH SYSTEM
Subdivision Name
CHRISTUS Santa Rosa Imaging Center - Alamo Heights
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450237E
Medicare Provider Number
450237
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/28/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/17/2012
Last Recertification Date
8/31/2016
Termination Date
Termination Reason
1/1/2017
DSH percentage below statutory minimum
Contacts
Authorizing Official
The Children's Hospital of San Antonio
Linda Kirks, Regional VP/CFO
(210) 704-2624
Primary Contact
CHRISTUS Santa Rosa Health System
Dustyn Tysdal, REGIONAL DIRECTOR OF PHARMACY
(210) 704-0130
Addresses
Street Address
423 Treeline Park
Suite 100
San Antonio, TX 78209
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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