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DSH450015R DALLAS COUNTY HOSPITAL DISTRICT dba PARKLAND HEALTH AND HOSPITAL SYSTEM (Terminated)
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Main Details
Name
DALLAS COUNTY HOSPITAL DISTRICT dba PARKLAND HEALTH AND HOSPITAL SYSTEM
Subdivision Name
Woodrow Long Youth & Family Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450015R
Medicare Provider Number
450015
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/11/2013
Last Recertification Date
8/31/2021
Termination Date
Termination Reason
10/1/2022
Site closure
Contacts
Authorizing Official
Parkland Health
Vivian B. Johnson, Senior Vice President
(469) 419-1946
Primary Contact
Parkland Health
Mayank Shah, Pharmacy 340B Program Manager
(469) 419-1964
Addresses
Street Address
6006 Reiger Ave
Dallas, TX 75214
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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