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SCH140189-00 SARAH BUSH LINCOLN HEALTH CENTER (Terminated)
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Main Details
Name
SARAH BUSH LINCOLN HEALTH CENTER
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH140189-00
Medicare Provider Number
140189
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2018
Participating Start Date
7/1/2018
Participating Approval Date
5/11/2018
Last Recertification Date
9/4/2024
Termination Date
Termination Reason
4/1/2025
DSH percentage below statutory minimum
Contacts
Authorizing Official
Sarah Bush Lincoln
Erica Stollard, Vice President of Operations
(217) 258-2106
Primary Contact
Sarah Bush Lincoln Health Center
Matthew Wade Clifton, Director of Pharmacy
(217) 258-2520
Addresses
Street Address
1000 HEALTH CENTER DRIVE
MATTOON, IL 61938
Billing Address
SARAH BUSH LINCOLN HEALTH CENTER DBA PRAIRIE MEDICAL PHARMACY
1000 HEALTH CENTER DRIVE
MATTOON, IL 61938
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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