340B Drug Pricing Program Database
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CAH041306-00 IZARD REGIONAL HOSPITAL, LLC (Active)
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Main Details
Name
IZARD REGIONAL HOSPITAL, LLC
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH041306-00
Medicare Provider Number
041306
Additional Details
Current Program Status
Active
Registration Date
1/16/2023
Participating Start Date
4/1/2023
Participating Approval Date
3/13/2023
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Izard Regional Hospital
Richard Harley Smith, Interim Administrator
(219) 230-9682
Primary Contact
Boa Vida Healthcare
Lisa Tang, 340B Program Director
(317) 324-1466
Addresses
Street Address
61 GRASSE ST
CALICO ROCK, AR 72519
Billing Address
Izard Regional Hospital, LLC
10996 Four Seasons Place
100C
Crown Point, IN 46307-7762
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 4/1/2012; Terminated 10/1/2013; Reinstated 4/1/2023.
03/13/2023
April 2025
April 2025
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