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DSH140164A MEMORIAL HOSPITAL OF CARBONDALE (Active)
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Main Details
Name
MEMORIAL HOSPITAL OF CARBONDALE
Subdivision Name
D.B.A. WEST FRANKFORT FAMILY MEDICI
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140164A
Medicare Provider Number
140164
Outpatient Facility Provider Number
143454
Additional Details
Current Program Status
Active
Registration Date
10/1/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/9/2015
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
2553 KEN GRAY BLVD
WEST FRANKFORT, IL 62896-4174
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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