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SCH450052-00 Goodall-Witcher Hospital Authority DBA Goodall-Witcher Hospital (Terminated)
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Main Details
Name
Goodall-Witcher Hospital Authority DBA Goodall-Witcher Hospital
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH450052-00
Medicare Provider Number
450052
Additional Details
Current Program Status
Terminated
Registration Date
7/9/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/9/2013
Last Recertification Date
8/19/2015
Termination Date
Termination Reason
10/1/2016
Change of covered entity type
Contacts
Authorizing Official
Goodall-Witcher Hospital Authority
Adam B. Willmann, CEO
(254) 675-8322 Ext: 7992
Primary Contact
Goodall-Witcher Hospital Authority
David Zschiesche, Pharmacy Director
(254) 326-8378
Addresses
Street Address
101 Posey Avenue
Clifton, TX 76634
Billing Address
Goodall-Witcher Hospital Authority
PO Box 549
Clifton, TX 76634
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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