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DSH450571V SHANNON MEDICAL CENTER (Active)
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Main Details
Name
SHANNON MEDICAL CENTER
Subdivision Name
SHANNON NUCLEAR MED MAGDALEN 7047 - Nuclear Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450571V
Medicare Provider Number
450571
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/2/2023
Participating Start Date
1/1/2024
Participating Approval Date
10/4/2023
Last Recertification Date
8/30/2024
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
102 N MAGDALEN
STE 310A
SAN ANGELO, TX 76903
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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