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DSH010099 D W MCMILLAN MEMORIAL HOSPITAL (Active)
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Main Details
Name
D W MCMILLAN MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH010099
Medicare Provider Number
010099
Additional Details
Current Program Status
Active
Registration Date
10/6/2022
Participating Start Date
11/15/2022
Participating Approval Date
11/2/2022
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
D.W. McMillan Memorial Hospital
Stacy Hines, Administrator
(251) 809-8429
Primary Contact
D W McMillan Memorial Hospital
Amy Holland, Pharmacy Director
(251) 809-8333
Addresses
Street Address
1301 BELLEVILLE AVENUE
BREWTON, AL 36427
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (7/1/2004) until terminated effective date: (10/1/2022), reinstatement effective date: (11/15/2022)
01/05/2023
May 2025
May 2025
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