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RRC450102-15 CHRISTUS MOTHER FRANCES HOSP-TYLER (Terminated)
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Main Details
Name
CHRISTUS MOTHER FRANCES HOSP-TYLER
Subdivision Name
CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services
Type
Rural Referral Center
Rural
No
340B ID
RRC450102-15
Medicare Provider Number
450102
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2020
Participating Start Date
8/13/2020
Participating Approval Date
8/11/2020
Last Recertification Date
8/20/2021
Termination Date
Termination Reason
3/10/2022
Change of hospital entity type
Contacts
Authorizing Official
CHRISTUS MF - Tyler
Elizabeth Pulliam, Chief Financial Officer
(903) 606-4102
Primary Contact
Christus Mother Frances, Jacksonville
Joshua Ward, 340B Coordinator
(903) 606-7591
Addresses
Street Address
20208 STATE HIGHWAY 155 S
FLINT, TX 75762-5600
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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