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RRC140135-23 Decatur Memorial Hospital (Terminated)
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Main Details
Name
Decatur Memorial Hospital
Subdivision Name
West Hay Family Medicine
Type
Rural Referral Center
Rural
No
340B ID
RRC140135-23
Medicare Provider Number
140135
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/27/2017
Participating Start Date
4/1/2017
Participating Approval Date
3/13/2017
Last Recertification Date
8/17/2021
Termination Date
Termination Reason
4/1/2022
Site closure
Contacts
Authorizing Official
Decatur Memorial Hospital
Deborah L. Bragg, Senior VP, Finance
(217) 876-2107
Primary Contact
Decatur Memorial Hospital
Paul William Robinson, 340B Coordinator
(217) 876-2031
Addresses
Street Address
West Hay Medical Center
304 W. Hay Street
Suite 218
Decatur, IL 62526
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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