340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH010024C JACKSON HOSPITAL AND CLINIC INC (Active)
Print
Main Details
Name
JACKSON HOSPITAL AND CLINIC INC
Subdivision Name
JACKSON HOSPITAL WOUND CARE CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH010024C
Medicare Provider Number
010024
Outpatient Facility Provider Number
010024
Additional Details
Current Program Status
Active
Registration Date
8/30/2022
Participating Start Date
9/7/2022
Participating Approval Date
9/7/2022
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Jackson Hospital and Clinics
Thomas Hudson Cobb, Director of Pharmacy
(334) 293-8806
Primary Contact
Jackson Hospital & Clinic, Inc.
Ashley Cherie Forbus, 340B Program Manager
(334) 293-8788
Addresses
Street Address
1801 PINE STREET SUITE 101
MONTGOMERY, AL 36106
Billing Address
Jackson Hospital and Clinic
1725 Pine street
Montgomery, AL 36106
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
1
to
1
of
1
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
1
to
1
of
1
Page:
of 1
Go
Page size:
Change
Participating Start Date 10/1/2014, Termination 10/1/2015, Reinstatement 9/7/2022
09/07/2022
April 2025
April 2025
week
S
M
T
W
T
F
S
14
30
31
1
2
3
4
5
15
6
7
8
9
10
11
12
16
13
14
15
16
17
18
19
17
20
21
22
23
24
25
26
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session