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CAH250010-00 TIPPAH COUNTY HOSPITAL (Terminated)
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Main Details
Name
TIPPAH COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH250010-00
Medicare Provider Number
250010
Additional Details
Current Program Status
Terminated
Registration Date
7/9/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/21/2015
Last Recertification Date
8/21/2018
Termination Date
Termination Reason
10/1/2019
Other
Contacts
Authorizing Official
Tippah County Hospital
Patrick Chapman, CEO
(662) 837-9221
Primary Contact
Tippah County Hospital
LeAnn Martindale, Director of Pharmacy
(662) 837-2199
Addresses
Street Address
1005 CITY AVE N
RIPLEY, MS 38663
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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