340B Drug Pricing Program Database
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DSH450054FD SCOTT AND WHITE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
SCOTT AND WHITE MEMORIAL HOSPITAL
Subdivision Name
Baylor Scott & White McLane Children's Medical Center - Blood Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450054FD
Medicare Provider Number
450054
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/5/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/28/2017
Last Recertification Date
9/5/2022
Termination Date
Termination Reason
7/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Baylor Scott & White Medical Center - Temple
Shahin Motakef, CEO
(254) 724-6583
Primary Contact
Baylor Scott & White Medical Center - Lake Pointe
Rosie Rosatti, Pharmacist Specialist
(512) 522-7337
Addresses
Street Address
1901 SW H K DODGEN LOOP
TEMPLE, TX 76502
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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