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DSH450015AZ DALLAS CO. HOSP. DIST. (Terminated)
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Main Details
Name
DALLAS CO. HOSP. DIST.
Subdivision Name
Chronic Kidney Disease
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450015AZ
Medicare Provider Number
450015
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
2/18/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/8/2016
Last Recertification Date
8/29/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
Parkland Health
Vivian B. Johnson, Senior Vice President
(469) 419-1946
Primary Contact
Parkland Health
Vivian B. Johnson, Senior Vice President
(469) 419-1946
Addresses
Street Address
5201 Harry Hines Blvd.
Dallas, TX 75235
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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