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DSH450039BR TARRANT COUNTY HOSPITAL DISTRICT, JOHN PETER SMITH HOSPITAL (Terminated)
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Main Details
Name
TARRANT COUNTY HOSPITAL DISTRICT, JOHN PETER SMITH HOSPITAL
Subdivision Name
Medical Procedures Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450039BR
Medicare Provider Number
450039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/6/2016
Last Recertification Date
9/14/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Tarrant County Hospital District d/b/a JPS Health Network
Karen Scott Duncan, President, CEO JPS Health Network
(817) 702-2318
Primary Contact
Tarrant County Hospital District d/b/a/ JPS Health Network
Nicole Shoquist, Chief Pharmacy Officer
(806) 674-2644
Addresses
Street Address
1450 8th Avenue
Fort Worth, TX 76104
Billing Address
JPS Health Network
1500 S Main St
Fort Worth, TX 76104
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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