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DSH440002D JACKSON-MADISON COUNTY GENERAL HOSP (Terminated)
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Main Details
Name
JACKSON-MADISON COUNTY GENERAL HOSP
Subdivision Name
JACKSON MADISON COUNTY GENERAL HOSP - Humboldt Emergency Department
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH440002D
Medicare Provider Number
440002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/24/2019
Participating Start Date
4/1/2019
Participating Approval Date
2/5/2019
Last Recertification Date
9/11/2019
Termination Date
Termination Reason
1/1/2020
Site closure
Contacts
Authorizing Official
West Tennessee Healthcare
Jeff Blankenship, CFO
(731) 541-6739
Primary Contact
West Tn Healthcare
Sherry Osborne, Executive Director of Pharmacy
(731) 541-6229
Addresses
Street Address
3525 CHERE CAROL RD
HUMBOLDT, TN 38343-3638
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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