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CAH141313-00 MASON DISTRICT HOSPITAL (Active)
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Main Details
Name
MASON DISTRICT HOSPITAL
Subdivision Name
MASON DISTRICT HOSPITAL
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH141313-00
Medicare Provider Number
141313
Additional Details
Current Program Status
Active
Registration Date
4/6/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/21/2020
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Mason District Hospital
Leann Kay Bonnett, CFO
(309) 543-8505
Primary Contact
Mason District Hospital
Jeremiah Vance, Director of Pharmacy
(309) 543-8501
Addresses
Street Address
615 NORTH PROMENADE STREET
HAVANA, IL 62644-0530
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2013; Terminated 1/1/2018; Reinstated 7/1/2020.
04/20/2020
April 2025
April 2025
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