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DSH450032AE GOOD SHEPHERD MEDICAL CENTER - MARSHALL (Terminated)
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Main Details
Name
GOOD SHEPHERD MEDICAL CENTER - MARSHALL
Subdivision Name
CHRISTUS Trinity Clinic CV Surg LV - Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450032AE
Medicare Provider Number
450032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/30/2019
Last Recertification Date
9/9/2020
Termination Date
Termination Reason
1/1/2021
Change of covered entity type
Contacts
Authorizing Official
Good Shepherd Medical Center
Michael Cheek, CFO
(903) 315-1814
Primary Contact
Christus Good Shepherd Medical Center
Jonathan Brown, Director of Pharmacy
(903) 315-2019
Addresses
Street Address
700 E Marshall
Longview, TX 75601-5544
Billing Address
CHRISTUS Good Shepherd
700 E Marshall
Longview, TX 75601
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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