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DSH250128 PANOLA MEDICAL CENTER (Terminated)
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Main Details
Name
PANOLA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250128
Medicare Provider Number
250128
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2021
Participating Start Date
7/1/2021
Participating Approval Date
5/7/2021
Last Recertification Date
8/31/2022
Termination Date
Termination Reason
10/1/2023
DSH percentage below statutory minimum
Contacts
Authorizing Official
Panola Medical Center
Quentin Q Whitwell, CEO
(662) 712-1515
Primary Contact
Panola Medical Center
Chris B Ware, COO
(662) 712-2329
Addresses
Street Address
303 MEDICAL CENTER DRIVE
BATESVILLE, MS 38606
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (10/1/2018) until terminated effective date: (10/1/2019), reinstatement effective date: (07/01/2021)
05/07/2021
April 2025
April 2025
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