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DSH450032AP GOOD SHEPHERD MEDICAL CENTER (Terminated)
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Main Details
Name
GOOD SHEPHERD MEDICAL CENTER
Subdivision Name
CHRISTUS Trinity Clinic - Podiatry LGV - Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450032AP
Medicare Provider Number
450032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/4/2022
Participating Start Date
7/1/2022
Participating Approval Date
5/12/2022
Last Recertification Date
8/25/2022
Termination Date
Termination Reason
1/1/2023
Business decision by the Covered Entity
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
705 E. Marshall
Suite 5001
Longview, TX 75601-5524
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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