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DSH010024B JACKSON HOSPITAL AND CLINIC, INC. (Terminated)
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Main Details
Name
JACKSON HOSPITAL AND CLINIC, INC.
Subdivision Name
JACKSON HOSPITAL SLEEP DISORDERS CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH010024B
Medicare Provider Number
010024
Outpatient Facility Provider Number
010024
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/12/2014
Last Recertification Date
8/20/2015
Termination Date
Termination Reason
10/1/2015
DSH percentage below statutory minimum
Contacts
Authorizing Official
Jackson Hospital
Joe Riley, CEO
(334) 293-8809
Primary Contact
LARRY SHERBETT, AVP-FINANCE
(334) 293-8820
Addresses
Street Address
1722 PINE STREET SUITE 900
MONTGOMERY, AL 36106
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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