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CAH251302-12 BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL (Terminated)
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Main Details
Name
BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL
Subdivision Name
MRH Commercial Clinic - Aberdeen
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH251302-12
Medicare Provider Number
251302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/6/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/23/2020
Last Recertification Date
8/24/2021
Termination Date
Termination Reason
10/1/2022
Other
Contacts
Authorizing Official
Boa Vida Hospital of Aberdeen LLC., dba Monroe Regional Hospital
Chris Chandler, CEO
(662) 369-2455
Primary Contact
Boa Vida Hospital of Aberdeen LLC., dba Monroe Regional Hospital
Lauren Wrighton Murray, 340B Program Coordinator
(662) 319-2074
Addresses
Street Address
502 Jackson St
Ste 5
Aberdeen, MS 39730-3300
Billing Address
Boa Vida Healthcare, LLC
10757 Randolph Street
Crown Point, IN 46307
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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