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DSH450237AW SANTA ROSA HEALTHCARE (Active)
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Main Details
Name
SANTA ROSA HEALTHCARE
Subdivision Name
Alon Emergency Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450237AW
Medicare Provider Number
450237
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/13/2023
Participating Start Date
7/1/2023
Participating Approval Date
4/20/2023
Last Recertification Date
8/15/2024
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
11503 Northwest Military Highway
Suite 122
San Antonio, TX 78230
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
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