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DSH180017Q TJ SAMSON COMMUNITY HOSPITAL (Terminated)
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Main Details
Name
TJ SAMSON COMMUNITY HOSPITAL
Subdivision Name
TOMPKINSVILLE CLINIC - TOMPKINSVILLE CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH180017Q
Medicare Provider Number
180017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/4/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/9/2018
Last Recertification Date
8/29/2018
Termination Date
Termination Reason
10/1/2019
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
TJ Regional Health
Neil Thornbury, CEO
(270) 651-4159
Primary Contact
TJ Regional Health
John Thomas Rogers, Compliance Officer
(270) 651-4513
Addresses
Street Address
800 N. Main Street
Suite B
Tompkinsville, KY 42167
Billing Address
TJ Samson Community Hospital
1301 NORTH RACE STREET
GLASGOW, KY 42141
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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