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CAH371301-00 PRAGUE REGIONAL MEMORIAL HOSPITAL (Active)
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Main Details
Name
PRAGUE REGIONAL MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH371301-00
Medicare Provider Number
371301
Additional Details
Current Program Status
Active
Registration Date
4/13/2021
Participating Start Date
7/1/2021
Participating Approval Date
4/20/2021
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Prague Regional Memorial Hospital
Shaelene Fipps, CEO
(405) 380-5576
Primary Contact
Cohesive Healthcare Management & Consulting
Miranda Walz-Allen, Project Manager
(620) 213-2125
Addresses
Street Address
1322 KLABZUBA AVENUE
PRAGUE, OK 74864
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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