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DSH450571U SHANNON MEDICAL CENTER (ToBeTerminated)
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Main Details
Name
SHANNON MEDICAL CENTER
Subdivision Name
SHANNON MEDICAL CENTER-ST JOHN CAMP - OP WOUNDCARE 7110
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450571U
Medicare Provider Number
450571
Outpatient Facility Provider Number
Additional Details
Current Program Status
ToBeTerminated
Registration Date
4/14/2022
Participating Start Date
7/1/2022
Participating Approval Date
5/6/2022
Last Recertification Date
8/30/2024
Termination Date
Termination Reason
7/1/2025
Site closure
Contacts
Authorizing Official
Shannon Medical Center
Joseph Wooldridge, Chief Financial Officer
(325) 657-5303
Primary Contact
Shannon Medical Center
Stephanie McCann, Pharmacy Director
(325) 747-5287
Addresses
Street Address
2018 PULLIAM ST
SAN ANGELO, TX 76905-5148
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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