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CAH171381-02 Memorial Hospital (Terminated)
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Main Details
Name
Memorial Hospital
Subdivision Name
Village Manor
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH171381-02
Medicare Provider Number
171381
Outpatient Facility Provider Number
175244
Additional Details
Current Program Status
Terminated
Registration Date
8/21/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/4/2012
Last Recertification Date
8/12/2016
Termination Date
Termination Reason
1/1/2018
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Hospital District No. 1 of Dickinson County, KS
Reginald Harold Courtois, CEO
(785) 263-6610
Primary Contact
Hospital District #1 of Dickinson
Lisa Wright, Pharmacist
(785) 263-6682
Addresses
Street Address
705 N. Brady
Abilene, KS 67410
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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