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DSH250167 METHODIST H/C OLIVE BRANCH HOSPT (Active)
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Main Details
Name
METHODIST H/C OLIVE BRANCH HOSPT
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH250167
Medicare Provider Number
250167
Additional Details
Current Program Status
Active
Registration Date
1/4/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/8/2019
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Methodist Healthcare - Memphis Hospitals
Chuck Lane, SVP/Associate CFO
(901) 516-0549
Primary Contact
Methodist Le Bonheur Healthcare
Chris Hilty, Director - Pharmacy Supply Chain
(901) 516-7570
Addresses
Street Address
4250 BETHEL ROAD
OLIVE BRANCH, MS 38654
Billing Address
Methodist Healthcare - Olive Branch
P.O. Box 41058
Memphis, TN 38174
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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