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DSH450104A GUADALUPE REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
GUADALUPE REGIONAL MEDICAL CENTER
Subdivision Name
Guadalupe Clinic for Chronic Disease Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450104A
Medicare Provider Number
450104
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/7/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/17/2015
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Guadalupe Regional Medical Center
Kody Bryan Gann, Chief Financial Officer
(830) 401-7721
Primary Contact
Guadalupe Regional Medical Center
Scott Mozisek, Director of Pharmacy
(830) 379-2411
Addresses
Street Address
1350 Ashby, Suite B
Seguin, TX 78155
Billing Address
Guadalupe Clinic for Chronic Disease Care
1215 E Court
Seguin, TX 78155
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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