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DSH450054AM SCOTT AND WHITE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
SCOTT AND WHITE MEMORIAL HOSPITAL
Subdivision Name
SCOTT AND WHITE WACO MACARTHUR PEDIATRIC CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450054AM
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
8/17/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Baylor Scott & White Medical Center - Temple
Shahin Motakef, CEO
(254) 724-6583
Primary Contact
Emory Martin, Director of Pharmacy CTX Region
(254) 724-3891
Addresses
Street Address
2201 MACARTHUR DRIVE
WACO, TX 76708
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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