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CAH251312-01 TYLER HOLMES MEMORIAL HOSPITAL (Active)
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Main Details
Name
TYLER HOLMES MEMORIAL HOSPITAL
Subdivision Name
TYLER HOLMES MEMORIAL HOSPITAL - Family Medicine
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH251312-01
Medicare Provider Number
251312
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/7/2021
Participating Start Date
10/1/2021
Participating Approval Date
8/16/2021
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Tyler Holmes Memorial Hospital
Cori H Bailey, Administrator
(662) 283-4114 Ext: 6126
Primary Contact
Tyler Holmes Memorial Hospital
Jessica Mooney, Pharmacist
(662) 283-8287
Addresses
Street Address
WINONA FAMILY PRACTICE
700 WOODLAND DRIVE
WINONA, MS 38967-1530
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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