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SCH450573-00 JASPER MEMORIAL HOSPITAL (Active)
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Main Details
Name
JASPER MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH450573-00
Medicare Provider Number
450573
Additional Details
Current Program Status
Active
Registration Date
10/4/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/21/2024
Last Recertification Date
Contacts
Authorizing Official
CHRISTUS
Nikki Martin, Regional Director, Finance
(409) 899-7105
Primary Contact
Christus Jaspeer Memorial
Kirk Vital, Director Of Pharmacy
(409) 381-5616
Addresses
Street Address
1275 MARVIN HANCOCK DR
JASPER, TX 75951
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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