Covered Entity Details

DSH450571E SHANNON MEDICAL CENTER (Terminated)

Main Details

Name

SHANNON MEDICAL CENTER

Subdivision Name

Shannon Infusion Clinic

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH450571E

Medicare Provider Number

450571

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/5/2016

Participating Start Date

1/1/2017

Participating Approval Date

11/16/2016

Last Recertification Date

Termination Date
Termination Reason

4/1/2017
DSH percentage below statutory minimum

Contacts

Authorizing Official

Staci Wetz, Chief Financial Officer
(325) 481-8416

Primary Contact

Shannon Medical Center
Steve Lubke, Director of Pharmacy Services
(325) 657-5189

Addresses

Street Address

2018 Pulliam
San Angelo, TX 76905

Billing Address

Shannon Medical Center
120 E. Harris Ave
San Angelo, TX 76903

Comment	Last Updated On
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1 Item 1 to 3 of 3 Page: of 1 Page size:
11/16/16 Participating starting 7/1/2015 until terminated effective 4/1/2016, reinstated effective 1/1/2017.	11/16/2016
5/28/15 CE reinstated effective 7/1/2015, was participating from 1/1/2012 to 6/30/2013, not participating from 7/1/2013 to 6/30/2015 due to DSH percentage below statutory minimum; 7/17/13-This child site became ineligible as of July 1, 2103, the same day as the parent. The parent reported a DSH percentage that dropped below the statutory minimum threshold.	07/01/2015
7/17/13-This child site became ineligible as of July 1, 2103, the same day as the parent. The parent reported a DSH percentage that dropped below the statutory minimum threshold.	07/18/2013

340B Drug Pricing Program Database