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CAH141311-00 FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION (Active)
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Main Details
Name
FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH141311-00
Medicare Provider Number
141311
Additional Details
Current Program Status
Active
Registration Date
5/24/2011
Participating Start Date
7/1/2011
Participating Approval Date
6/15/2011
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Fairfield Memorial Hospital
Rachel Ewing, Chief Nursing Officer
(618) 847-8283
Primary Contact
Fairfield Memorial Hospital
Lance Endsley, Director of Pharmacy
(618) 847-8255
Addresses
Street Address
303 NW 11TH STREET
FAIRFIELD, IL 62837
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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