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DSH140164C MEMORIAL HOSPITAL OF CARBONDALE (Active)
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Main Details
Name
MEMORIAL HOSPITAL OF CARBONDALE
Subdivision Name
Cancer Treatment Center - Oncology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140164C
Medicare Provider Number
140164
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/1/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/17/2015
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
SIH
Warren Ladner, CFO
(618) 457-5200 Ext: 67130
Primary Contact
Southern Illinois Healthcare - Carbondale, IL
Katelyn Morgan, 340B Coordinator
(618) 457-5200 Ext: 67205
Addresses
Street Address
1400 Pin Oak Drive
Carterville, IL 62918
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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