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SCH370022-01 JACKSON COUNTY MEMORIAL HOSPITAL (Active)
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Main Details
Name
JACKSON COUNTY MEMORIAL HOSPITAL
Subdivision Name
HOSPICE / JACKSON COUNTY MEMORIAL HOSPITAL HOSPICE
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH370022-01
Medicare Provider Number
370022
Outpatient Facility Provider Number
371540
Additional Details
Current Program Status
Active
Registration Date
7/10/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/3/2014
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Jackson County Memorial Hospital
Shelley Simmons, VP of Patient Care
(580) 379-5533
Primary Contact
Jackson County Memorial Hospital
RETA BENNETT, DIRECTOR OF PHARMACY
(580) 379-5708
Addresses
Street Address
1204 E TAMARACK RD
JACKSON COUNTY MEMORIAL HOSPITAL HOSPICE
ALTUS, OK 73521-1234
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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