340B Drug Pricing Program Database
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DSH450032BP GOOD SHEPHERD MEDICAL CENTER (Terminated)
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Main Details
Name
GOOD SHEPHERD MEDICAL CENTER
Subdivision Name
CHRISTUS TRINITY CLINIC - INTERNAL MED MSH - INTERNAL MED MSH
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450032BP
Medicare Provider Number
450032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/4/2022
Participating Start Date
7/1/2022
Participating Approval Date
5/31/2022
Last Recertification Date
8/25/2022
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Good Shepherd Medical Center
Michael Cheek, CFO
(903) 315-1814
Primary Contact
Christus Health
Drake Dudley, Manager of Pharmacy Services
(903) 315-2938
Addresses
Street Address
811 S WASHINGTON AVE
STE 100
Marshall, TX 75670
Billing Address
Good Shepherd Medical Center
700 E. Marshall Ave.
Longview, TX 75601
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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