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CAH141313-01 MASON DISTRICT HOSPITAL (Active)
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Main Details
Name
MASON DISTRICT HOSPITAL
Subdivision Name
MASON HOSPITAL DISTRICT - Manito Medical Associates
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH141313-01
Medicare Provider Number
141313
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/8/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/21/2020
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Mason District Hospital
Leann Kay Bonnett, CFO
(309) 543-8505
Primary Contact
Mason District Hospital
Jeremiah Vance, Director of Pharmacy
(309) 543-8501
Addresses
Street Address
1301 S EAST AVE
MANITO, IL 61546-8909
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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