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SCH010109-00 PICKENS COUNTY MEDICAL CENTER (Terminated)
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Main Details
Name
PICKENS COUNTY MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH010109-00
Medicare Provider Number
010109
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2018
Participating Start Date
1/1/2019
Participating Approval Date
11/9/2018
Last Recertification Date
8/28/2019
Termination Date
Termination Reason
10/1/2020
Failure to recertify
Contacts
Authorizing Official
Pickens County Medical Center
Richard McBryde, CFO
(205) 367-8111
Primary Contact
Pickens County Health Care Authority
David P Handley, Pharmacy Director
(205) 367-8111 Ext: 274
Addresses
Street Address
241 ROBERT K WILSON DRIVE
CARROLLTON, AL 35447
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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