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RRC450571-00 SHANNON MEDICAL CENTER (Terminated)
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Main Details
Name
SHANNON MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC450571-00
Medicare Provider Number
450571
Additional Details
Current Program Status
Terminated
Registration Date
10/2/2020
Participating Start Date
1/1/2021
Participating Approval Date
10/26/2020
Last Recertification Date
Termination Date
Termination Reason
7/1/2021
Change of covered entity type
Contacts
Authorizing Official
Shannon Medical Center
Joseph Wooldridge, Chief Financial Officer
(325) 657-5303
Primary Contact
Shannon Medical Center
Steve Lubke, Director of Pharmacy Services
(325) 657-5189
Addresses
Street Address
120 EAST HARRIS AVENUE
SAN ANGELO, TX 76903
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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