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DSH450039BG TARRANT COUNTY HOSPITAL DISTRICT, JOHN PETER SMITH HOSPITAL (Terminated)
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Main Details
Name
TARRANT COUNTY HOSPITAL DISTRICT, JOHN PETER SMITH HOSPITAL
Subdivision Name
JPS FAMILY HEALTH CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450039BG
Medicare Provider Number
450039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/4/2014
Last Recertification Date
12/1/2017
Termination Date
Termination Reason
7/1/2018
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
JPS Health Network
Sharon R Clark, Senior Executive Vice President, CFO
(817) 702-6833
Primary Contact
Tarrant County Hospital District d/b/a/ JPS Health Network
Nicole Shoquist, Chief Pharmacy Officer
(806) 674-2644
Addresses
Street Address
1500S MAIN ST
JPS HEALTH NETWORK
FORT WORTH, TX 76104-4917
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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