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RRC450032-00 GOOD SHEPHERD MEDICAL CENTER (Terminated)
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Main Details
Name
GOOD SHEPHERD MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC450032-00
Medicare Provider Number
450032
Additional Details
Current Program Status
Terminated
Registration Date
10/9/2020
Participating Start Date
11/30/2020
Participating Approval Date
11/3/2020
Last Recertification Date
8/18/2021
Termination Date
Termination Reason
7/1/2022
Change of covered entity type
Contacts
Authorizing Official
Good Shepherd Medical Center
Michael Cheek, CFO
(903) 315-1814
Primary Contact
Christus Good Shepherd Medical Center
Jonathan Brown, Director of Pharmacy
(903) 315-2019
Addresses
Street Address
811 SOUTH WASHINGTON
MARSHALL, TX 75670
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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