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RRC450237-48 CHRISTUS SANTA ROSA HEALTH SYSTEM (Terminated)
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Main Details
Name
CHRISTUS SANTA ROSA HEALTH SYSTEM
Subdivision Name
RAS SEROLOGY - Lab Services
Type
Rural Referral Center
Rural
No
340B ID
RRC450237-48
Medicare Provider Number
450237
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/28/2020
Last Recertification Date
8/25/2022
Termination Date
Termination Reason
7/1/2023
Change of covered entity type
Contacts
Authorizing Official
CHRISTUS Santa Rosa
Steve Chen, CFO
(210) 321-8031
Primary Contact
CHRISTUS Santa Rosa Medical Center
Phillip Morris, Director of Pharmacy
(210) 705-6193
Addresses
Street Address
403 Treeline Park
San Antonio, TX 78209
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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