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SCH040067-00 MAGNOLIA REGIONAL HEALTH SYSTEM INC (ToBeTerminated)
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Main Details
Name
MAGNOLIA REGIONAL HEALTH SYSTEM INC
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH040067-00
Medicare Provider Number
040067
Additional Details
Current Program Status
ToBeTerminated
Registration Date
4/1/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/23/2024
Last Recertification Date
9/9/2024
Termination Date
Termination Reason
7/1/2025
DSH percentage below statutory minimum
Contacts
Authorizing Official
Magnolia Regional Medical Center
Brett Kinman, CEO
(870) 235-3212
Primary Contact
Magnolia Regional Medical Center
William Joseph Van Noy, Chief Financial Officer
(870) 235-3185
Addresses
Street Address
101 Hospital Drive
MAGNOLIA, AR 71753
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (10/01/2013) until terminated effective date: (10/01/2016); reinstatement effective date: (07/1/2024)
04/23/2024
April 2025
April 2025
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