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DSH450571H SHANNON MEDICAL CENTER (Terminated)
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Main Details
Name
SHANNON MEDICAL CENTER
Subdivision Name
Dialysis Services-Brady
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450571H
Medicare Provider Number
450571
Outpatient Facility Provider Number
453514
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
2008 NINE RD
SHANNON DIALYSIS SERVICES - BRADY
BRADY, TX 76825-7210
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
May 2025
May 2025
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