340B Drug Pricing Program Database
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DSH140239 Javon Bea Hospital (Active)
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Main Details
Name
Javon Bea Hospital
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140239
Medicare Provider Number
140239
Additional Details
Current Program Status
Active
Registration Date
11/23/2007
Participating Start Date
1/1/2008
Participating Approval Date
11/26/2007
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Mercy Health
Shannon Dunphy-Alexander, Senior Vice President / CFO
(608) 757-3126
Primary Contact
Mercyhealth
Clark Montgomery, System Manager of Pharmacy Business and 340B Program
(406) 698-8719
Addresses
Street Address
8201 E Riverside Blvd
Rockford, IL 61114
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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