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RRC140135-07 Decatur Memorial Hospital (Terminated)
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Main Details
Name
Decatur Memorial Hospital
Subdivision Name
Express Care North
Type
Rural Referral Center
Rural
No
340B ID
RRC140135-07
Medicare Provider Number
140135
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/26/2017
Participating Start Date
4/1/2017
Participating Approval Date
3/13/2017
Last Recertification Date
8/25/2020
Termination Date
Termination Reason
10/1/2020
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Decatur Memorial Hospital
Deborah L. Bragg, Senior VP, Finance
(217) 876-2107
Primary Contact
Decatur Memorial Hospital
Kristi Stice, Director, Pharmacy
(217) 876-6201
Addresses
Street Address
3131 N. Water Street
Decatur, IL 62526
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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