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DSH450597A DEWITT MEDICAL DISTRICT DBA CUERO REGIONAL HOSPITAL (Active)
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Main Details
Name
DEWITT MEDICAL DISTRICT DBA CUERO REGIONAL HOSPITAL
Subdivision Name
DEWITT MEDICAL DISTRICT - Parkside Family Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450597A
Medicare Provider Number
450597
Outpatient Facility Provider Number
673423
Additional Details
Current Program Status
Active
Registration Date
4/12/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/14/2016
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
DeWitt Medical District
Alma Alexander, CFO
(361) 275-6191
Primary Contact
Cuero Regional Hospital
William Michael Marshall, Director of Pharmacy
(361) 275-0559
Addresses
Street Address
1109E BROADWAY ST
PARKSIDE FAMILY CLINIC
CUERO, TX 77954-2108
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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