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DSH450801G CHRISTUS ST MICHAEL (Terminated)
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Main Details
Name
CHRISTUS ST MICHAEL
Subdivision Name
Atlanta - Surgery General
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450801G
Medicare Provider Number
450801
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/12/2015
Last Recertification Date
8/28/2018
Termination Date
Termination Reason
4/1/2019
Other
Contacts
Authorizing Official
CHRISTUS St. Michael
Jason Rounds, Interim President and CEO
(903) 614-2003
Primary Contact
CHRISTUS St. Michael Health System
Dale Smith, Director of Pharmacy Services
(903) 614-2928
Addresses
Street Address
1007 SOUTH WILLIAMS STREET
ATLANTA, TX 75551-3245
Billing Address
CHRISTUS St. Michael Health System
2600 St. Michael Dr.
Texarkana, TX 75503
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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