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DSH450054BA SCOTT AND WHITE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
SCOTT AND WHITE MEMORIAL HOSPITAL
Subdivision Name
SCOTT AND WHITE PEDIATRIC DENTISTRY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450054BA
Medicare Provider Number
450054
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/8/2014
Participating Start Date
7/1/2014
Participating Approval Date
4/10/2014
Last Recertification Date
8/29/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
Baylor Scott & White Medical Center - Temple
Shahin Motakef, CEO
(254) 724-6583
Primary Contact
Scott & White Medical Center - Temple
Sara Rainey, Pharmacy Specialist
(254) 724-2081
Addresses
Street Address
1901 SW H K DODGEN LOOP
BUILDING 300
TEMPLE, TX 76502
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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