340B Drug Pricing Program Database
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DSH040071F JEFFERSON REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
JEFFERSON REGIONAL MEDICAL CENTER
Subdivision Name
Healthworks / MTM
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040071F
Medicare Provider Number
040071
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/15/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/4/2014
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Jefferson Hospital Association, Inc.
Jeremy Jeffery, Senior Vice President & Chief Financial Officer
(870) 541-5945
Primary Contact
Jeffeson Regional Medical Center
Kenneth Alan Hawk, 340B Program Director
(870) 541-3340
Addresses
Street Address
4201 South Mulberry
Suite A
PINE BLUFF, AR 71603
Billing Address
Jefferson Regional Medical Center
1600 West 40th Avenue
Pine Bluff, AR 71603
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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