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DSH450054AU SCOTT AND WHITE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
SCOTT AND WHITE MEMORIAL HOSPITAL
Subdivision Name
Scott & White Roney Bone & Joint Institute/Hand Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450054AU
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
8/15/2018
Termination Date
Termination Reason
4/1/2019
Other
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
2401 SOUTH 31ST STREET
BUILDING 35, Third floor
TEMPLE, TX 76508
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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