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RRC010024-20 JACKSON HOSPITAL AND CLINIC INC (Terminated)
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Main Details
Name
JACKSON HOSPITAL AND CLINIC INC
Subdivision Name
OP infusion Clinic - Outpatient infusions Clinic
Type
Rural Referral Center
Rural
Yes
340B ID
RRC010024-20
Medicare Provider Number
010024
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2019
Participating Start Date
10/1/2019
Participating Approval Date
8/5/2019
Last Recertification Date
9/1/2022
Termination Date
Termination Reason
9/7/2022
Change of hospital entity type
Contacts
Authorizing Official
Jackson Hospital
Joe Riley, CEO
(334) 293-8809
Primary Contact
Jackson Hospital and Clinics
Thomas Hudson Cobb, Director of Pharmacy
(334) 293-8806
Addresses
Street Address
1725 pine street
2 East
Montgomery, AL 36106
Billing Address
Jackson Hospital and Clinic Inc.
1725 pine street
Montgomery, AL 36106
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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