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SCH450210-00 East Texas Medical Center Carthage (Terminated)
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Main Details
Name
East Texas Medical Center Carthage
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH450210-00
Medicare Provider Number
450210
Additional Details
Current Program Status
Terminated
Registration Date
4/10/2013
Participating Start Date
7/1/2013
Participating Approval Date
5/15/2013
Last Recertification Date
11/8/2017
Termination Date
Termination Reason
4/1/2018
For-Profit conversion
Contacts
Authorizing Official
East Texas Medical Center Carthage
Gary Hudson, Administrator
(903) 694-4652
Primary Contact
East Texas Medical Center
Daphne Philo, pharmacy supervisor
(903) 694-4890
Addresses
Street Address
409 West Cottage Road
Carthage, TX 75633
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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