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DSH450237AV SANTA ROSA HEALTHCARE (ToBeTerminated)
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Main Details
Name
SANTA ROSA HEALTHCARE
Subdivision Name
Creekside Crossing ED
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450237AV
Medicare Provider Number
450237
Outpatient Facility Provider Number
Additional Details
Current Program Status
ToBeTerminated
Registration Date
4/13/2023
Participating Start Date
7/1/2023
Participating Approval Date
4/20/2023
Last Recertification Date
8/15/2024
Termination Date
Termination Reason
7/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
CHRISTUS Santa Rosa
Steve Chen, CFO
(210) 321-8031
Primary Contact
CHRISTUS Santa Rosa Health System
Dustyn Tysdal, REGIONAL DIRECTOR OF PHARMACY
(210) 704-0130
Addresses
Street Address
244 Creekside Crossing
New Braunfels, TX 78130
Billing Address
CHRISTUS SANTA ROSA HEALTH SYSTEM
2827 BABCOCK ROAD
SAN ANTONIO, TX 78229
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (01/1/2014) until terminated effective date: (01/01/2017), reinstatement effective date: (07/1/2023)
04/20/2023
April 2025
April 2025
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