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DSH250099A GREENWOOD LEFLORE HOSPITAL (Terminated)
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Main Details
Name
GREENWOOD LEFLORE HOSPITAL
Subdivision Name
WALK IN CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250099A
Medicare Provider Number
250099
Outpatient Facility Provider Number
258566
Additional Details
Current Program Status
Terminated
Registration Date
7/6/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/13/2013
Last Recertification Date
8/11/2016
Termination Date
Termination Reason
1/1/2018
Site closure
Contacts
Authorizing Official
Greenwood Lefore Hospital
Dawne Holmes, CFO
(662) 459-7119
Primary Contact
Greenwood Leflore Hospital
Dean Kidd, DIRECTOR OF PHARMACY
(662) 459-2633
Addresses
Street Address
706 HWY 82
SUITE B
Greenwood, MS 38930
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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