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CAH111333-00 JEFF DAVIS (Active)
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Main Details
Name
JEFF DAVIS
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH111333-00
Medicare Provider Number
111333
Additional Details
Current Program Status
Active
Registration Date
7/13/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/21/2020
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Jeff Davis Hospital
Leif E England, Controller
(912) 699-6201
Primary Contact
Jeff Davis Hospital
Alexis Leggett, Pharmacy Director
(912) 375-7781 Ext: 6211
Addresses
Street Address
163 S TALLAHASSEE ST
HAZLEHURST, GA 31539
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 4/1/2017, terminated 10/1/2018. Reinstated 10/1/2020.
07/21/2020
May 2025
May 2025
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