340B Drug Pricing Program Database
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DSH040071R JEFFERSON REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
JEFFERSON REGIONAL MEDICAL CENTER
Subdivision Name
Ambulatory Surgery Center - Outpatient Surgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040071R
Medicare Provider Number
040071
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/8/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/22/2019
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Jefferson Hospital Association, Inc.
Jeremy Jeffery, Senior Vice President & Chief Financial Officer
(870) 541-5945
Primary Contact
Jeffeson Regional Medical Center
Kenneth Alan Hawk, 340B Program Director
(870) 541-3340
Addresses
Street Address
1609 West 40th Ave
Pine Bluff, AR 71603
Billing Address
Jefferson Regional Medical Center
1600 West 40th Avenue
Pine Bluff, AR 71603
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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