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RRC450011-24 ST. JOSEPH REGIONAL HEALTH CENTER (Terminated)
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Main Details
Name
ST. JOSEPH REGIONAL HEALTH CENTER
Subdivision Name
CHI ST JOSEPH HEALTH CS EMERGENCY - Emergency room
Type
Rural Referral Center
Rural
No
340B ID
RRC450011-24
Medicare Provider Number
450011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/2/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/3/2019
Last Recertification Date
8/21/2020
Termination Date
Termination Reason
1/1/2021
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
4411 HIGHWAY 6 S
COLLEGE STATION, TX 77845-4428
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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