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CAH251338-01 Sharkey Issaquena Community Hospital (Terminated)
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Main Details
Name
Sharkey Issaquena Community Hospital
Subdivision Name
SHARKEY-ISSAQUENA NURSING HOME - Outpatient
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH251338-01
Medicare Provider Number
251338
Outpatient Facility Provider Number
255220
Additional Details
Current Program Status
Terminated
Registration Date
7/7/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/30/2020
Last Recertification Date
8/15/2023
Termination Date
Termination Reason
10/1/2024
Failure to recertify
Contacts
Authorizing Official
Sharkey Issaquena Community Hospital
Steven Gerald Keever, CEO
(662) 873-4395 Ext: 150
Primary Contact
SHARKEY ISSAQUENA COMM HOSP
BRANDON L STOKES, Director of Pharmacy
(662) 873-5149
Addresses
Street Address
47 South 4th St
Rolling Fork, MS 39159
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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