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DSH140012C KATHERINE SHAW BETHEA (Terminated)
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Main Details
Name
KATHERINE SHAW BETHEA
Subdivision Name
Commerce Towers / Rheumatology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140012C
Medicare Provider Number
140012
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/11/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/21/2017
Last Recertification Date
8/21/2018
Termination Date
Termination Reason
7/1/2019
DSH percentage below statutory minimum
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
215 E. First St
Dixon, IL 61021
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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