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CAH281319-00 JEFFERSON COMMUNITY HEALTH CENTER DBA JEFFERSON COMMUNITY HEALTH & LIFE (Active)
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Main Details
Name
JEFFERSON COMMUNITY HEALTH CENTER DBA JEFFERSON COMMUNITY HEALTH & LIFE
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH281319-00
Medicare Provider Number
281319
Additional Details
Current Program Status
Active
Registration Date
9/16/2010
Participating Start Date
1/1/2011
Participating Approval Date
10/14/2010
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Jefferson Community Health & Life
Chance Klasek, CFO
(402) 729-6856
Primary Contact
Jefferson Community Health & Life
Penni Mitchell, 340B & Pharmacy Revenue Cycle Coordinator
(402) 729-6881
Addresses
Street Address
2200 H ST
FAIRBURY, NE 68352
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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07/25/11 removed NPI &Medicaid#(was 470468078, 1194944819 )
03/23/2012
07/25/11 removed NPI &Medicaid#(was 470468078, 1194944819 )
07/25/2011
07/25/11 removed Medicaid#(was 470468078 )
07/25/2011
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