340B Drug Pricing Program Database
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RRC450011-22 ST. JOSEPH REGIONAL HEALTH CENTER (Terminated)
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Main Details
Name
ST. JOSEPH REGIONAL HEALTH CENTER
Subdivision Name
CHI St Joseph Health MatureWell Lifestyle Center - CHI St Joseph Health MatureWell Lifestyle Center
Type
Rural Referral Center
Rural
No
340B ID
RRC450011-22
Medicare Provider Number
450011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/3/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/30/2018
Last Recertification Date
Termination Date
Termination Reason
1/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
CHI St. Joseph Regional Health Center
Ricardo Diaz, Chief Operating Officer
(979) 776-2580
Primary Contact
Catholic Health Initiatives
Chad E Gay, 340B Division Manager
(281) 804-7802
Addresses
Street Address
3989 N Shore Drive
Bryan, TX 77807
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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