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CAH251304-02 TALLAHATCHIE GENERAL HOSPITAL (Active)
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Main Details
Name
TALLAHATCHIE GENERAL HOSPITAL
Subdivision Name
TALLAHATCHIE GENERAL HOSPITAL- HOLCOMB CLINIC
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH251304-02
Medicare Provider Number
251304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/10/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/28/2017
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Tallahatchie General Hospital
James D. Blackwood, CEO
(662) 625-5535
Primary Contact
Tallahatchie General Hospital
Stephanie Sinquefield, Director of Pharmacy
(662) 625-7194
Addresses
Street Address
1301 SUNSET DR
HOLCOMB CLINIC
SUITE E
GRENADA, MS 38901
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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