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CAH451363-00 JACKSON COUNTY HOSPITAL (Active)
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Main Details
Name
JACKSON COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH451363-00
Medicare Provider Number
451363
Additional Details
Current Program Status
Active
Registration Date
8/10/2022
Participating Start Date
10/1/2022
Participating Approval Date
8/26/2022
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Jackson County Hospital District
Lance Smiga, CEO
(361) 782-7800
Primary Contact
Jackson County Hospital District
Carrie Folmar, County Indigent Coordinator
(361) 782-7842
Addresses
Street Address
1013 SOUTH WELLS
EDNA, TX 77957-4098
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (10/1/2011) until terminated effective date: (10/1/2013), reinstatement effective date: (10/1/2022)
08/26/2022
May 2025
May 2025
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