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DSH450064 TEXAS HEALTH ARLINGTON MEMORIAL HOSP (Active)
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Main Details
Name
TEXAS HEALTH ARLINGTON MEMORIAL HOSP
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450064
Medicare Provider Number
450064
Additional Details
Current Program Status
Active
Registration Date
1/13/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/30/2023
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Texas Health Arlington Memorial Hospital
Tammy Kaye Ormuz, Entity Finance Officer
(817) 960-6127
Primary Contact
Texas Health Arlington Memorial Hospital
Nolan Rashad Martin, Director of Pharmacy
(817) 960-6367
Addresses
Street Address
800 W RANDOL MILL ROAD
ARLINGTON, TX 76012
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2017, terminated 7/1/2018. Reinstated 4/1/2023.
01/27/2023
May 2025
May 2025
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