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CAH161366-02 Shenandoah Medical Center (Active)
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Main Details
Name
Shenandoah Medical Center
Subdivision Name
SHENANDOAH MEDICAL CENTER - Tabor Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH161366-02
Medicare Provider Number
161366
Outpatient Facility Provider Number
168645
Additional Details
Current Program Status
Active
Registration Date
10/14/2021
Participating Start Date
1/1/2022
Participating Approval Date
11/1/2021
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Shenandoah Medical Center
Matthew Richard Sells, President and CEO
(712) 246-7160
Primary Contact
Shenandoah Medical Center
Amanda Renee Mather, Director of Pharmacy
(712) 246-7137
Addresses
Street Address
400 MAIN ST
TABOR, IA 51653-2031
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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