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RRC140135-42 Decatur Memorial Hospital (Active)
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Main Details
Name
Decatur Memorial Hospital
Subdivision Name
South Shores Imaging Center
Type
Rural Referral Center
Rural
No
340B ID
RRC140135-42
Medicare Provider Number
140135
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/5/2019
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Decatur Memorial Hospital
Drew Early, President CEO
(217) 876-2114
Primary Contact
Decatur Memorial Hospital
Paul William Robinson, 340B Coordinator
(217) 876-2031
Addresses
Street Address
1689 S FRANKLIN STREET RD
DECATUR, IL 62521-4018
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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