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DSH040071B JEFFERSON REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
JEFFERSON REGIONAL MEDICAL CENTER
Subdivision Name
WHITE HALL HEALTH COMPLEX PHYSICAL THERAPY CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040071B
Medicare Provider Number
040071
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/8/2009
Participating Start Date
10/1/2009
Participating Approval Date
9/23/2009
Last Recertification Date
8/28/2023
Termination Date
Termination Reason
8/29/2023
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Jefferson Regional Medical Center
BRYAN JACKSON, CHIEF ADMINISTRATIVE OFFICER
(870) 541-7141
Primary Contact
Jeffeson Regional Medical Center
Kenneth Alan Hawk, 340B Program Director
(870) 541-3340
Addresses
Street Address
1600 WEST HOLLAND AVENUE
WHITE HALL, AR 71602
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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