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DSH100142 JACKSON HOSPITAL (Active)
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Main Details
Name
JACKSON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100142
Medicare Provider Number
100142
Additional Details
Current Program Status
Active
Registration Date
3/10/2010
Participating Start Date
4/1/2010
Participating Approval Date
3/15/2010
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Jackson Hospital
Brooke G Donaldson, CEO
(850) 718-2622
Primary Contact
JACKSON HOSPITAL
RODNEY ALLEN LEWIS, DIRECTOR, PHARMACY SERVICES
(850) 718-2609
Addresses
Street Address
4250 HOSPITAL DRIVE
MARIANNA, FL 32446
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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