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DSH450039AZ TCHD D/B/A JPS HEALTH NETWORK (Terminated)
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Main Details
Name
TCHD D/B/A JPS HEALTH NETWORK
Subdivision Name
JPS FAMILY MEDICINE & URG CARE CTR / Family Medicine. Eye Clinic.
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450039AZ
Medicare Provider Number
450039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2014
Participating Start Date
1/1/2015
Participating Approval Date
10/29/2014
Last Recertification Date
9/5/2015
Termination Date
Termination Reason
10/1/2015
Site closure
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
1741 E. BARDIN RD
JPS HEALTH NETWORK
ARLINGTON, TX 76018-4836
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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