340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
RRC010024-04 JACKSON HOSPITAL AND CLINIC INC (Terminated)
Print
Main Details
Name
JACKSON HOSPITAL AND CLINIC INC
Subdivision Name
JACKSON CLINIC VASCULAR SURGERY - Vascular Surgery
Type
Rural Referral Center
Rural
Yes
340B ID
RRC010024-04
Medicare Provider Number
010024
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/6/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/12/2017
Last Recertification Date
9/1/2022
Termination Date
Termination Reason
9/7/2022
Change of hospital entity type
Contacts
Authorizing Official
Jackson Hospital
Joe Riley, CEO
(334) 293-8809
Primary Contact
Jackson Hospital and Clinics
Thomas Hudson Cobb, Director of Pharmacy
(334) 293-8806
Addresses
Street Address
1758 PARK PLACE
300
MONTGOMERY, AL 36106-1137
Billing Address
Jackson Hosptial and Clinic
1725 Pine St
Montgomery, AL 36106
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.
June 2025
June 2025
week
S
M
T
W
T
F
S
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
24
8
9
10
11
12
13
14
25
15
16
17
18
19
20
21
26
22
23
24
25
26
27
28
27
29
30
1
2
3
4
5
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