340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH140012A KATHERINE SHAW BETHEA (Terminated)
Print
Main Details
Name
KATHERINE SHAW BETHEA
Subdivision Name
KATHERINE SHAW BETHEA HOSPITAL / Edwards Clinic (Internal Medicine)
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140012A
Medicare Provider Number
140012
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/20/2017
Last Recertification Date
Termination Date
Termination Reason
7/1/2017
Site closure
Contacts
Authorizing Official
Katherine Shaw Bethea Hospital
Julie D. Mann, VP/CAO
(815) 285-5538
Primary Contact
Katherine Shaw Bethea Hospital
Julie D. Mann, VP/CAO
(815) 285-5538
Addresses
Street Address
403 E FIRST ST
DIXON, IL 61021-3116
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
May 2025
May 2025
week
S
M
T
W
T
F
S
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
20
11
12
13
14
15
16
17
21
18
19
20
21
22
23
24
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session