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DSH440048AY BAPTIST MEM HOSPITAL MEMPHIS (Terminated)
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Main Details
Name
BAPTIST MEM HOSPITAL MEMPHIS
Subdivision Name
Baptist Memphis Plaza Diagnostic Pavilion
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH440048AY
Medicare Provider Number
440048
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/17/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/28/2017
Last Recertification Date
9/11/2019
Termination Date
Termination Reason
7/1/2020
Other
Contacts
Authorizing Official
Baptist Memorial Health Care Corporation
Kimberly Young, Vice President-Finance Operations
(901) 227-4080
Primary Contact
Baptist Memorial Health Care Corp
Donna C Cox, Director 340B
(901) 227-5144
Addresses
Street Address
6029 Walnut Grove Road, Suite C002
Memphis, TN 38120
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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