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CAH041314-00 DEWITT HOSPITAL & NURSING HOME INC (Terminated)
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Main Details
Name
DEWITT HOSPITAL & NURSING HOME INC
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH041314-00
Medicare Provider Number
041314
Additional Details
Current Program Status
Terminated
Registration Date
10/9/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/15/2018
Last Recertification Date
9/6/2023
Termination Date
Termination Reason
10/1/2024
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
DeWitt Hospital & Nursing Home
Brian Miller, CEO
(870) 946-3571 Ext: 2208
Primary Contact
DeWitt Hospital and Nursing Home
Angie Duncan, Pharmacy Technician
(870) 946-3571 Ext: 2219
Addresses
Street Address
1641 S. Whitehead Dr
DEWITT, AR 72042
Billing Address
DeWitt Hospital & Nursing Home Inc
P.O. Box 32
DeWitt, AR 72042
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating start date 10/1/2017; Terminated 1/1/2018; Reinstated 1/1/2019.
10/12/2018
7/7/17 Participating 7/1/2012 until terminated effective 10/1/2016, reinstated effective 10/1/2017
07/07/2017
April 2025
April 2025
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