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DSH010109 PICKENS COUNTY HEALTH CARE AUTHORITY (Terminated)
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Main Details
Name
PICKENS COUNTY HEALTH CARE AUTHORITY
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH010109
Medicare Provider Number
010109
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2008
Participating Start Date
7/1/2004
Participating Approval Date
4/14/2008
Last Recertification Date
11/29/2017
Termination Date
Termination Reason
7/1/2018
Other
Contacts
Authorizing Official
Pickens County Health Care Authority
Richard McBryde, CEO/CFO
(205) 367-8111 Ext: 101
Primary Contact
Pickens County Health care Authority
David Paul Handley, Pharmacy Director
(205) 367-8111
Addresses
Street Address
241 ROBERT K WILSON DRIVE
CARROLLTON, AL 35447
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/12/08-CORRECTED NAME TO MATCH WITH NAME ON UPDATED DEA (WAS PICKENS COUNTY HOSPITAL); 4/26/05 - EDIT NAME FROM MEDICAL CENTER TO HOSPITAL
04/21/2008
April 2025
April 2025
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