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RRC450011-02 ST. JOSEPH REGIONAL HEALTH CENTER (Terminated)
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Main Details
Name
ST. JOSEPH REGIONAL HEALTH CENTER
Subdivision Name
CHI St Joseph Health Orthopaedic Associates - CHI St Joseph Health Orthopaedic Associates
Type
Rural Referral Center
Rural
No
340B ID
RRC450011-02
Medicare Provider Number
450011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/4/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/20/2018
Last Recertification Date
8/17/2023
Termination Date
Termination Reason
1/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
St. Joseph Regional Health Center
Erin Marietta, VP Operations
(443) 956-3099
Primary Contact
St. Joseph Regional Health Center
Kimberly Feese, Market Director Pharmacy
(979) 776-2506
Addresses
Street Address
2803 Earl Rudder Fwy.
103
College Station, TX 77845
Billing Address
St. Josph Health Reg Hlth Ctr
PO Box 636000
Littleton, CO 80163-6000
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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