340B Drug Pricing Program Database
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DSH040071 JEFFERSON REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
JEFFERSON REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040071
Medicare Provider Number
040071
Additional Details
Current Program Status
Active
Registration Date
1/3/2008
Participating Start Date
4/1/2000
Participating Approval Date
1/3/2008
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Jefferson Hospital Association, Inc.
Jeremy Jeffery, Senior Vice President & Chief Financial Officer
(870) 541-5945
Primary Contact
Jeffeson Regional Medical Center
Kenneth Alan Hawk, 340B Program Director
(870) 541-3340
Addresses
Street Address
1600 WEST 40TH AVENUE
PINE BLUFF, AR 71603
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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9/2/2003 - ADDRESS CHANGE (WAS 1515 WEST 42ND AVENUE)
01/03/2008
May 2025
May 2025
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