Covered Entity Details

DSH450571F SHANNON MEDICAL CENTER (Terminated)

Main Details

Name

SHANNON MEDICAL CENTER

Subdivision Name

Woundcare & Hyperbaric Clinic

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH450571F

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 76905-5148

Billing Address

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

Comment	Last Updated On
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11/16/16 Participating starting 7/1/2015 until terminated effective 4/1/2016 due to DSH percentage below statutory minimum, reinstated 1/1/2017.	11/16/2016
5/22/15 participating 4/1/12 thru 6/30/13, not participating 7/1/13 thru 6/30/15, reinstated based on on-line registration submitted in April 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.	05/22/2015
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