340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH450032AW GOOD SHEPHERD MEDICAL CENTER (Terminated)
Print
Main Details
Name
GOOD SHEPHERD MEDICAL CENTER
Subdivision Name
GOOD SHEPHERD MEDICAL CTR - Cardiac Rehab
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450032AW
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
8/31/2023
Termination Date
Termination Reason
7/1/2024
Other
Contacts
Authorizing Official
Good Shepherd Medical Center
Michael Cheek, CFO
(903) 315-1814
Primary Contact
Christus Health
Drake Dudley, Manager of Pharmacy Services
(903) 315-2938
Addresses
Street Address
3133 Good Shepherd Way
Longview, TX 75605-7921
Billing Address
GOOD SHEPHERD MEDICAL CENTER
700 E. MARSHALL AVENUE
LONGVIEW, TX 75601
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
1
to
1
of
1
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
1
to
1
of
1
Page:
of 1
Go
Page size:
Change
Participated starting 7/1/2019; Terminated 1/1/2021; Reinstated 7/1/2022.
05/11/2022
April 2025
April 2025
week
S
M
T
W
T
F
S
14
30
31
1
2
3
4
5
15
6
7
8
9
10
11
12
16
13
14
15
16
17
18
19
17
20
21
22
23
24
25
26
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session