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CAH141305-06 Memorial Hospital Association (Active)
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Main Details
Name
Memorial Hospital Association
Subdivision Name
D/B/A MEMORIAL MEDICAL CLINICS CARTHAGE / Gero Psych - Outpatient Geriatric Counceling
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH141305-06
Medicare Provider Number
141305
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/17/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/31/2016
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Memorial Hospital Assoication
Teresa Smith, CFO
(217) 357-8573
Primary Contact
Memorial Hospital
Ada Bair, CEO
(217) 357-8566
Addresses
Street Address
D/B/A MEMORIAL MEDICAL CLINICS CARTHAGE
1450 N COUNTY RD 2050
CARTHAGE, IL 62321
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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