340B Drug Pricing Program Database
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CAH041323-04 ASHLEY COUNTY MEDICAL CENTER (Active)
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Main Details
Name
ASHLEY COUNTY MEDICAL CENTER
Subdivision Name
CROSSETT HEALTH FOUNDATION - Family Clinic Provider Based
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH041323-04
Medicare Provider Number
041323
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/8/2021
Participating Start Date
4/1/2021
Participating Approval Date
1/14/2021
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
ashley county medcal center
PHILLIP GILMORE, CHIEF EXECUTIVE OFFICER
(870) 364-4111 Ext: 271
Primary Contact
ashley county medical center
dawn lanae burchfield, director of pharmacy
(870) 364-1248
Addresses
Street Address
909 UNITY RD STE B
FAMILY CLINIC OF ASHLEY COUNTY
CROSSETT, AR 71635-9444
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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