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DSH450571D SHANNON MEDICAL CENTER (Terminated)
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Main Details
Name
SHANNON MEDICAL CENTER
Subdivision Name
Shannon Dialysis Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450571D
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
12/15/2016
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
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating starting 7/1/2015 until terminated effective 4/1/2016 due to DSH percentage below statutory minimum, reinstated 1/1/2017.
12/15/2016
5/26/15 participating 1/1/12 thru 6/30/13, not participating 7/1/13 thru 6/30/15 due to DSH % dropping below statutory minimum, reinstated based on on-line registration submitted in April 2015
05/26/2015
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
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