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DSH450346L BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL (Terminated)
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Main Details
Name
BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL
Subdivision Name
Outpatient Infusion - Woodville - Infusion
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450346L
Medicare Provider Number
450346
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/16/2019
Last Recertification Date
8/27/2021
Termination Date
Termination Reason
10/1/2022
Site closure
Contacts
Authorizing Official
Baptist Hospitals of Southeast Texas
Gary Troutman, Chief Financial Officer
(409) 212-5003
Primary Contact
Baptist Hospitals of Southeast Texas
Aily Powell, Administrative Director of Pharmacy
(409) 212-7282
Addresses
Street Address
1100 W. Bluff St.
Woodville, TX 75979
Billing Address
Baptist Hospitals of Southeast Texas
PO Box 1591
Beaumont, TX 77704
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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