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CAH141304-01 Genesis Medical Center, Aledo (Active)
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Main Details
Name
Genesis Medical Center, Aledo
Subdivision Name
GMC Aledo - Genesis Health Group Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH141304-01
Medicare Provider Number
141304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/5/2013
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Genesis Medical Center Aledo
Edward Rogalski, Administrator
(309) 582-3700
Primary Contact
Genesis Medical Center, Aledo
Elizabeth M DeWalsche, Pharmacist Supervisor
(309) 582-9184
Addresses
Street Address
1007 NW 3rd St.
Aledo, IL 61231
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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