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CAH251326-00 Jefferson Davis Community Hospital (Active)
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Main Details
Name
Jefferson Davis Community Hospital
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH251326-00
Medicare Provider Number
251326
Additional Details
Current Program Status
Active
Registration Date
1/15/2014
Participating Start Date
4/1/2014
Participating Approval Date
2/27/2014
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Forrest General Hospital
Ben Hester, CFO
(601) 288-4225
Primary Contact
Jefferson Davis Community Hospital
Leslie Walker, Director of Pharmacy
(601) 792-1220
Addresses
Street Address
1102 Rose Street
Prentiss, MS 39474
Billing Address
Jefferson Davis General Hospital
PO Box 1288
Prentiss, MS 39474
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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