340B Drug Pricing Program Database
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DSH040071N JEFFERSON REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
JEFFERSON REGIONAL MEDICAL CENTER
Subdivision Name
Family Health Associates of South Arkansas
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040071N
Medicare Provider Number
040071
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/4/2016
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Jefferson Hospital Association, Inc.
Jeremy Jeffery, Senior Vice President & Chief Financial Officer
(870) 541-5945
Primary Contact
Jeffeson Regional Medical Center
Kenneth Alan Hawk, 340B Program Director
(870) 541-3340
Addresses
Street Address
4747 Dusty Lake Drive
2G
Pine Bluff, AR 71603
Billing Address
Jefferson Regional Medical Center
1600 West 40th Avenue
Pine Bluff, AR 71603
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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