340B Drug Pricing Program Database
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DSH250099E GREENWOOD LEFLORE HOSPITAL (Active)
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Main Details
Name
GREENWOOD LEFLORE HOSPITAL
Subdivision Name
ITTA BENA CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250099E
Medicare Provider Number
250099
Outpatient Facility Provider Number
253418
Additional Details
Current Program Status
Active
Registration Date
7/6/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/13/2013
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Greenwood Lefore Hospital
Dawne Holmes, CFO
(662) 459-7119
Primary Contact
Greenwood Leflore Hospital
Spencer Jennings, Director of Pharmacy
(662) 459-2633
Addresses
Street Address
103 BASKET ST
Itta Bena, MS 38941
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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