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DSH450032 GOOD SHEPHERD MEDICAL CENTER (Active)
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Main Details
Name
GOOD SHEPHERD MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450032
Medicare Provider Number
450032
Additional Details
Current Program Status
Active
Registration Date
5/4/2022
Participating Start Date
7/1/2022
Participating Approval Date
5/12/2022
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Good Shepherd Medical Center
Michael Cheek, CFO
(903) 315-1814
Primary Contact
CHRISTUS Good Shepherd Medical Center
Jamie Lee Georgiev, Senior Pharmacy Buyer
(903) 315-3127
Addresses
Street Address
700 E. MARSHALL AVENUE
LONGVIEW, TX 75601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2017; Terminated 1/1/2021; Reinstated 7/1/2022.
05/11/2022
10/28/16 Participating 4/1/2009 until terminated effective 10/1/2016, reinstated effective 1/1/2017.
10/28/2016
May 2025
May 2025
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