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RRC140135-31 Decatur Memorial Hospital (Terminated)
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Main Details
Name
Decatur Memorial Hospital
Subdivision Name
Shelbyville Medical Clinic - General Clinic
Type
Rural Referral Center
Rural
No
340B ID
RRC140135-31
Medicare Provider Number
140135
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/1/2018
Last Recertification Date
8/27/2019
Termination Date
Termination Reason
10/1/2020
Site closure
Contacts
Authorizing Official
Decatur Memorial Hospital
Deborah L. Bragg, Senior VP, Finance
(217) 876-2107
Primary Contact
Decatur Memorial Hospital
Kristi Stice, Director, Pharmacy
(217) 876-6201
Addresses
Street Address
415 N. Cedar St.
Shelbyville, IL 62565
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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