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RRC450011-17 ST. JOSEPH REGIONAL HEALTH CENTER (Terminated)
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Main Details
Name
ST. JOSEPH REGIONAL HEALTH CENTER
Subdivision Name
CHI St. Joseph Health Heart Failure Clinic - CHI St. Joseph Health Heart Failure Clinic
Type
Rural Referral Center
Rural
No
340B ID
RRC450011-17
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
9/8/2021
Termination Date
Termination Reason
10/1/2022
Site closure
Contacts
Authorizing Official
CHI St. Joseph Regional Health Center
Ricardo Diaz, Chief Operating Officer
(979) 776-2580
Primary Contact
CHI St. Joseph Regional Health Center
Kimberly Feese, Director of Pharmacy
(979) 776-2506
Addresses
Street Address
2700 E. 29th Street
325
Bryan, TX 77802
Billing Address
CHI St. Joseph Health Regional Hospital
2801 Franciscan Drive
Bryan, TX 77802
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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