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DSH450571 SHANNON MEDICAL CENTER (Active)
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Main Details
Name
SHANNON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450571
Medicare Provider Number
450571
Additional Details
Current Program Status
Active
Registration Date
4/14/2022
Participating Start Date
7/1/2022
Participating Approval Date
5/6/2022
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Shannon Medical Center
Joseph Wooldridge, Chief Financial Officer
(325) 657-5303
Primary Contact
Shannon Medical Center
Stephanie McCann, Pharmacy Director
(325) 747-5287
Addresses
Street Address
120 EAST HARRIS AVENUE
SAN ANGELO, TX 76903
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (01/01/2017) until terminated effective date: (04/01/2017), reinstatement effective date: (07/01/2022)
05/05/2022
11/16/16 Participating starting 7/1/2015 until terminated effective 4/1/2016, reinstated effective 1/1/2017
11/16/2016
CE reinstated effective 7/1/2015; was participating from 1/1/2005 to 6/30/2013; not participating from 7/1/2013 to 6/30/2015 due to DSH percentage below statutory minimum.
05/28/2015
10/12/11 REMOVED MEDICAID # (WAS 137226005); 9/27/07- DOC RECD TO CONFIRM ELIG DSH ADJ %
10/12/2011
9/27/07- DOC RECD TO CONFIRM ELIG DSH ADJ %
09/27/2007
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