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CAH141333-04 Schuyler County Hospital District dba Sarah D. Culbertson Memorial Hospital (Terminated)
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Main Details
Name
Schuyler County Hospital District dba Sarah D. Culbertson Memorial Hospital
Subdivision Name
Community Medical Clinic of Table Grove - Rural Health Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH141333-04
Medicare Provider Number
141333
Outpatient Facility Provider Number
148585
Additional Details
Current Program Status
Terminated
Registration Date
10/8/2018
Participating Start Date
1/1/2019
Participating Approval Date
11/21/2018
Last Recertification Date
8/29/2022
Termination Date
Termination Reason
10/1/2023
Site closure
Contacts
Authorizing Official
Schuyler County Hospital District
Tamra S Gadberry, Chief Financial Officer
(217) 322-5296
Primary Contact
Schuyler County Hospital District
Sarah Brockhouse, Pharmacist
(217) 322-4321 Ext: 5294
Addresses
Street Address
130 N Broadway Street
Table Grove, IL 61482-9593
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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