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RRC450237-53 CHRISTUS SANTA ROSA HEALTH SYSTEM (Terminated)
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Main Details
Name
CHRISTUS SANTA ROSA HEALTH SYSTEM
Subdivision Name
CHRISTUS SANTA ROSA ORTHOPEDIC & SPORTS MEDICINE CLINIC- WH - ORTHOPEDIC & SPORTS MEDICINE
Type
Rural Referral Center
Rural
No
340B ID
RRC450237-53
Medicare Provider Number
450237
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/6/2023
Participating Start Date
4/1/2023
Participating Approval Date
2/10/2023
Last Recertification Date
Termination Date
Termination Reason
7/1/2023
Change of covered entity type
Contacts
Authorizing Official
CHRISTUS Santa Rosa
Steve Chen, CFO
(210) 321-8031
Primary Contact
CHRISTUS Hospital Santa Rosa Medical Center
Emmanuel Aniemeke, Director of Pharmacy Services
(210) 705-6193
Addresses
Street Address
11212 STATE HIGHWAY 151
STE 200
San Antonio, TX 78251
Billing Address
CHRISTUS SANTA ROSA HEALTH SYSTEM
2827 BABCOCK ROAD
SAN ANTONIO, TX 78229
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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