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DSH450032L GOOD SHEPHERD MEDICAL CENTER (Terminated)
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Main Details
Name
GOOD SHEPHERD MEDICAL CENTER
Subdivision Name
Longview Northpark Emergency Department
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450032L
Medicare Provider Number
450032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/4/2022
Participating Start Date
7/1/2022
Participating Approval Date
5/12/2022
Last Recertification Date
8/31/2023
Termination Date
Termination Reason
4/1/2024
Other
Contacts
Authorizing Official
Good Shepherd Medical Center
Michael Cheek, CFO
(903) 315-1814
Primary Contact
Christus Health
Drake Dudley, Manager of Pharmacy Services
(903) 315-2938
Addresses
Street Address
323 East Hawkins Parkway
Longview, TX 75605
Billing Address
GOOD SHEPHERD MEDICAL CENTER
700 E. MARSHALL AVENUE
LONGVIEW, TX 75601
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2018; Terminated 1/1/2021; Reinstated 7/1/2022.
05/11/2022
April 2025
April 2025
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