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CAH451358-01 MEMORIAL HOSPITAL-SEMINOLE (Terminated)
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Main Details
Name
MEMORIAL HOSPITAL-SEMINOLE
Subdivision Name
Memorial Hospital Clinic West
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH451358-01
Medicare Provider Number
451358
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/28/2019
Last Recertification Date
8/21/2019
Termination Date
Termination Reason
4/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Seminole Memorial Hospital
Maegen Garner, Interim CEO
(432) 758-4814
Primary Contact
Seminole Memorial Hospital
Larry Gray, CEO
(432) 758-4814
Addresses
Street Address
1004 Hobbs Highway
4
Seminole, TX 79360
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date (1/1/2016) until terminated effective date (10/1/2018) reinstatement effective date (04/01/2019)
01/16/2019
Participating from effective date (11/9/2015) until terminated effective date (10/1/2018), reinstatement effective date (04/01/2019)
01/15/2019
May 2025
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