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CAH041328-00 Chicot Memorial Medical Center (Active)
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Main Details
Name
Chicot Memorial Medical Center
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH041328-00
Medicare Provider Number
041328
Additional Details
Current Program Status
Active
Registration Date
5/29/2012
Participating Start Date
4/17/2017
Participating Approval Date
6/7/2012
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Chicot Memorial Medical Center
John E Heard, Chief Executive Officer
(870) 265-9200
Primary Contact
Chicot Memorial Medical center
Kim Rice, Administrative Assistant
(870) 265-9200
Addresses
Street Address
Chicot Memorial Medical Center
2729 S. Hwy 65 & 82
Lake Village, AR 71653
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/14/17 Initial start date 7/1/2012, Term date 10/1/2016, Reinstate 4/17/2017. REGISTRATION WAS SUBMITTED DURING JANUARY 2017 REGISTRATION WINDOW, OPA FAILED TO APPROVE IT DUE TO OVERSIGHT, THEREFORE IT WAS APPROVED WITH IMMEDIATE START DATE ON 4/17/17
06/14/2017
Comments Initial start date 7/1/2012, Term date 10/1/2016, Reinstate 4/1/2017.
04/17/2017
June 2025
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