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CAH361301-00 Community Memorial Hospital (Terminated)
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Main Details
Name
Community Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH361301-00
Medicare Provider Number
361301
Additional Details
Current Program Status
Terminated
Registration Date
10/2/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/8/2013
Last Recertification Date
8/31/2023
Termination Date
Termination Reason
10/1/2024
Failure to recertify
Contacts
Authorizing Official
Community Memorial Hospital
Benjamin Sheperd, Director of Pharmacy
(567) 239-1476
Primary Contact
Community Memorial Hospital
Amanda Rose, Controller
(419) 542-6628
Addresses
Street Address
208 Columbus Street
Hicksville, OH 43526
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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