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DSH450032AJ GOOD SHEPHERD MEDICAL CENTER (Active)
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Main Details
Name
GOOD SHEPHERD MEDICAL CENTER
Subdivision Name
CTC Family Medicine NorthPark
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450032AJ
Medicare Provider Number
450032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
5/4/2022
Participating Start Date
7/1/2022
Participating Approval Date
5/12/2022
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Good Shepherd Medical Center
Michael Cheek, CFO
(903) 315-1814
Primary Contact
CHRISTUS Good Shepherd Medical Center
Jamie Lee Georgiev, Senior Pharmacy Buyer
(903) 315-3127
Addresses
Street Address
323 E. Hawkins Parkway
Suite A
Longview, TX 75605
Billing Address
GOOD SHEPHERD MEDICAL CENTER
700 E. MARSHALL AVENUE
LONGVIEW, TX 75601
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2019; Terminated 1/1/2021; Reinstated 7/1/2022.
05/11/2022
April 2025
April 2025
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