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DSH370149B ST ANTHONY SHAWNEE HOSPITAL (Terminated)
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Main Details
Name
ST ANTHONY SHAWNEE HOSPITAL
Subdivision Name
Urgent Care Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH370149B
Medicare Provider Number
370149
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/12/2014
Last Recertification Date
8/15/2016
Termination Date
Termination Reason
10/1/2017
Loss of qualifying grant/support
Contacts
Authorizing Official
- SSM ST ANTHONY HOSPITAL
Shasta Manuel, VP of Finance CFO
(405) 272-7282
Primary Contact
St. Anthony Shawnee Hospital
James Barnett, Pharmacy Director
(405) 395-5607
Addresses
Street Address
3200 Medical Park Drive
Shawnee, OK 74804
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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