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DSH450102AK CHRISTUS MOTHER FRANCES HOSP-TYLER (Active)
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Main Details
Name
CHRISTUS MOTHER FRANCES HOSP-TYLER
Subdivision Name
CHRISTUS Louis and Peaches Owen Heart Hospital Clinic Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450102AK
Medicare Provider Number
450102
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
3/2/2022
Participating Start Date
3/10/2022
Participating Approval Date
3/10/2022
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
CHRISTUS Mother Frances Health System
Eric Garrison, CFO
(903) 606-4102
Primary Contact
Christus Mother Frances, Jacksonville
Joshua Ward, 340B Coordinator
(903) 606-7591
Addresses
Street Address
703 S FLEISHEL AVE
Tyler, TX 75701
Billing Address
CHRISTUS MOTHER FRANCES HOSP - TYLER
800 East Dawson
Tyler, TX 75701
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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