340B Drug Pricing Program Database
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DSH140164 MEMORIAL HOSPITAL OF CARBONDALE (Active)
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Main Details
Name
MEMORIAL HOSPITAL OF CARBONDALE
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140164
Medicare Provider Number
140164
Additional Details
Current Program Status
Active
Registration Date
11/20/2008
Participating Start Date
1/1/2009
Participating Approval Date
12/15/2008
Last Recertification Date
9/10/2024
Contacts
Authorizing Official
SIH
Warren Ladner, CFO
(618) 457-5200 Ext: 67130
Primary Contact
Southern Illinois Healthcare - Carbondale, IL
Katelyn Morgan, 340B Coordinator
(618) 457-5200 Ext: 67205
Addresses
Street Address
405 WEST JACKSON STREET
CARBONDALE, IL 62901
Billing Address
SIH
PO Box 3988
Carbondale, IL 62902
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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