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DSH450237K CHRISTUS SANTA ROSA HEALTH SYSTEM (Terminated)
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Main Details
Name
CHRISTUS SANTA ROSA HEALTH SYSTEM
Subdivision Name
Rehabilitation Services - Occupational Therapy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450237K
Medicare Provider Number
450237
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/11/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/19/2012
Last Recertification Date
8/25/2015
Termination Date
Termination Reason
10/1/2015
Site closure
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
750 Landa Street
New Braunfels, TX 78130
Billing Address
CHRISTUS Santa Rosa Health System
333 North Santa Rosa Street
San Antonio, TX 78207
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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