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DSH040071L JEFFERSON REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
JEFFERSON REGIONAL MEDICAL CENTER
Subdivision Name
Neurosurgery Associates of South Arkansas
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040071L
Medicare Provider Number
040071
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/4/2014
Last Recertification Date
9/12/2018
Termination Date
Termination Reason
10/1/2019
Site closure
Contacts
Authorizing Official
Jefferson Regional Medical Center
BRYAN JACKSON, CHIEF ADMINISTRATIVE OFFICER
(870) 541-7141
Primary Contact
Jefferson Regional Medical Center
Lelan Stice, Director of Pharmacy
(870) 541-7908
Addresses
Street Address
1609 W 40th Ave
Suite 501
Pine Bluff, AR 71603
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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