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SCH140210-02 HARRISBURG MEDICAL CENTER INC. (Terminated)
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Main Details
Name
HARRISBURG MEDICAL CENTER INC.
Subdivision Name
Eldorado Primary Care
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH140210-02
Medicare Provider Number
140210
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2017
Participating Start Date
3/15/2022
Participating Approval Date
4/20/2017
Last Recertification Date
9/7/2023
Termination Date
Termination Reason
10/1/2023
DSH percentage below statutory minimum
Contacts
Authorizing Official
SIH
Warren Ladner, CFO
(618) 457-5200 Ext: 67130
Primary Contact
Harrisburg Medical Center, Inc.
Cody Sandusky, Director of Pharmacy
(618) 253-0263
Addresses
Street Address
1007 US Highway 45 North
Eldorado, IL 62930
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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