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DSH440049DD METHODIST H/C MEMPHIS HOSPT. (Terminated)
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Main Details
Name
METHODIST H/C MEMPHIS HOSPT.
Subdivision Name
Methodist Healthcare Oncology Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH440049DD
Medicare Provider Number
440049
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/7/2015
Participating Start Date
7/1/2015
Participating Approval Date
6/3/2015
Last Recertification Date
8/10/2016
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Methodist Healthcare - Memphis Hospitals
Chuck Lane, SVP/Associate CFO
(901) 516-0549
Primary Contact
Methodist Healthcare - Memphis Hospitals
Alison L. Apple, Administrative Director, Pharmacy
(901) 516-2292
Addresses
Street Address
1500 W Poplar Ave
Suite 304
Collierville, TN 38017
Billing Address
Methodist Healthcare - Memphis Hospitals
P.O. Box 41058
Memphis, TN 38174
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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