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DSH440002T JACKSON-MADISON COUNTY GENERAL HOSP (Active)
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Main Details
Name
JACKSON-MADISON COUNTY GENERAL HOSP
Subdivision Name
Infusion Clinic - Infusion Clinic Intravenous Therapy
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH440002T
Medicare Provider Number
440002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/5/2024
Participating Start Date
7/1/2024
Participating Approval Date
5/7/2024
Last Recertification Date
8/29/2024
Contacts
Authorizing Official
West Tennessee Healthcare
Jeff Blankenship, CFO
(731) 541-6739
Primary Contact
West Tennessee Healthcare
Dan Wichlan, Director of Pharmacy
(731) 541-5918
Addresses
Street Address
8 Medical Center Drive
Suite B
Jackson, TN 38301
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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