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DSH010101 CITIZENS BAPTIST MEDICAL CENTER (Terminated)
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Main Details
Name
CITIZENS BAPTIST MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH010101
Medicare Provider Number
010101
Additional Details
Current Program Status
Terminated
Registration Date
1/25/2008
Participating Start Date
1/1/2016
Participating Approval Date
1/25/2008
Last Recertification Date
Termination Date
Termination Reason
1/1/2016
Other
Contacts
Authorizing Official
Zach Abercrombie, CFO
(256) 761-4509
Primary Contact
James Easter, Director - Pharmacy
(256) 761-4546
Addresses
Street Address
604 STONE AVENUE
TALLADEGA, AL 35161
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 4/1/05 until terminated 10/10/15, reinstated effective 1/1/16
12/15/2015
April 2025
April 2025
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