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DSH450034AN CHRISTUS HOSPITAL (Terminated)
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Main Details
Name
CHRISTUS HOSPITAL
Subdivision Name
CHRISTUS SOUTHEAST TEXAS Center for Health Management St. Mary
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450034AN
Medicare Provider Number
450034
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/12/2015
Last Recertification Date
8/30/2016
Termination Date
Termination Reason
1/1/2018
DSH percentage below statutory minimum
Contacts
Authorizing Official
CHRISTUS Hospital
Paul Trevino, CEO, CHRISTUS Health Southeast Texas
(409) 899-7102
Primary Contact
CHRISTUS Hospital
Tommy Welch, Director of Pharmacy
(409) 899-7042
Addresses
Street Address
4640 Ninth Ave, Suite 103
Port Arthur, TX 77642
Billing Address
CHRISTUS SOUTHEAST TEXAS St. Mary
3600 Gates Blvd.
Port Arthur, TX 77642
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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