340B Drug Pricing Program Database
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DSH450051A METHODIST DALLAS MEDICAL CENTER (Active)
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Main Details
Name
METHODIST DALLAS MEDICAL CENTER
Subdivision Name
Golden Cross Academic Clinic / Teaching Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450051A
Medicare Provider Number
450051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/8/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/13/2015
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Methodist Health System
Jon T Albrecht, Corporate VP, Chief Pharmacy Officer
(214) 947-2504
Primary Contact
Methodist Dallas Medical Center
Ilka Ratsaphangthong, Director of Pharmacy
(214) 947-2481
Addresses
Street Address
122 W. Colorado Blvd
Dallas, TX 75208
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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