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CAH451362-02 CLAY COUNTY MEMORIAL HOSPITAL (Active)
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Main Details
Name
CLAY COUNTY MEMORIAL HOSPITAL
Subdivision Name
CCMH Clinic
Type
Critical Access Hospital
Rural
No
340B ID
CAH451362-02
Medicare Provider Number
451362
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/11/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/18/2017
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Clay County Memorial Hospital
DEBRA HAEHN, CFO
(940) 235-1202
Primary Contact
Clay County Memorial Hospital
Connie Garza, Pharmacy Tech
(940) 235-1202
Addresses
Street Address
102 S. Archer Street
Henrietta, TX 76365
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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