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DSH040071J JEFFERSON REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
JEFFERSON REGIONAL MEDICAL CENTER
Subdivision Name
Surgical Associates of SE Arkansas
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040071J
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
1601 W 40th Ave
Suite
301
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
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