340B Drug Pricing Program Database
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DSH450032CB GOOD SHEPHERD MEDICAL CENTER (Terminated)
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Main Details
Name
GOOD SHEPHERD MEDICAL CENTER
Subdivision Name
CHRISTUS TRINITY CLINIC - CV SURGERY LGV - CV SURGERY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450032CB
Medicare Provider Number
450032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/3/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/5/2023
Last Recertification Date
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
701 E MARSHALL AVE
STE 504
LONGVIEW, TX 75601
Billing Address
GOOD SHEPHERD MEDICAL CENTER
700 E. MARSHALL AVENUE
Longview, TX 75601
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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