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SCH450178-02 Pecos County Memorial Hospital (Terminated)
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Main Details
Name
Pecos County Memorial Hospital
Subdivision Name
George Rural Health Clinic
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH450178-02
Medicare Provider Number
450178
Outpatient Facility Provider Number
458894
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2013
Participating Start Date
7/1/2013
Participating Approval Date
5/20/2013
Last Recertification Date
8/20/2018
Termination Date
Termination Reason
10/1/2019
Other
Contacts
Authorizing Official
Pecos County Memorial Hospital
Betsy Briscoe, CEO
(432) 336-2004 Ext: 4200
Primary Contact
Pecos County Memorial Hospital
Gina Kalka, CNO
(432) 336-4203
Addresses
Street Address
511 N Main
Fort Stockton, TX 79735
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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