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CAH141305-13 Memorial Hospital Association (Active)
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Main Details
Name
Memorial Hospital Association
Subdivision Name
Memorial Hospital Association Provider Based Specialty - Dermatology
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH141305-13
Medicare Provider Number
141305
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/10/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/30/2020
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Memorial Hospital Assoication
Teresa Smith, CFO
(217) 357-8573
Primary Contact
Memorial Hospital
Ada Bair, CEO
(217) 357-8566
Addresses
Street Address
1450 North County 2050
Carthage, IL 62321
Billing Address
Memorial Hosptial
PO Box 160
Carthage, IL 62321
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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