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RRC010024-00 JACKSON HOSPITAL AND CLINIC INC (Terminated)
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Main Details
Name
JACKSON HOSPITAL AND CLINIC INC
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC010024-00
Medicare Provider Number
010024
Additional Details
Current Program Status
Terminated
Registration Date
1/4/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/15/2017
Last Recertification Date
9/6/2022
Termination Date
Termination Reason
9/7/2022
Change of hospital entity type
Contacts
Authorizing Official
Jackson Hospital
Joe Riley, CEO
(334) 293-8809
Primary Contact
Jackson Hospital and Clinics
Thomas Hudson Cobb, Director of Pharmacy
(334) 293-8806
Addresses
Street Address
1725 PINE STREET
MONTGOMERY, AL 36106-1109
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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