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SCH450085-00 Graham Regional Medical Center (Terminated)
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Main Details
Name
Graham Regional Medical Center
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH450085-00
Medicare Provider Number
450085
Additional Details
Current Program Status
Terminated
Registration Date
10/7/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/3/2013
Last Recertification Date
9/7/2016
Termination Date
Termination Reason
1/1/2017
DSH percentage below statutory minimum
Contacts
Authorizing Official
Graham Regional
Robert Shane Kernell, CEO
(940) 521-5302
Primary Contact
Stacey Jordan, Director of Pharmacy
(940) 521-5422
Addresses
Street Address
1301 Montgomery Road
Graham, TX 76450
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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