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RRC250100-00 BAPTIST MEM HOSPITAL GOLDEN TRIANGLE (Terminated)
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Main Details
Name
BAPTIST MEM HOSPITAL GOLDEN TRIANGLE
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC250100-00
Medicare Provider Number
250100
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2022
Participating Start Date
4/1/2022
Participating Approval Date
2/1/2022
Last Recertification Date
Termination Date
Termination Reason
4/1/2022
Other
Contacts
Authorizing Official
Baptist Memorial Health Care Corporation
Kimberly Young, Vice President-Finance Operations
(901) 227-4080
Primary Contact
Baptist Memorial Health Care Corp
Donna C Cox, Director 340B
(901) 227-5144
Addresses
Street Address
2520 FIFTH STREET NORTH
COLUMBUS, MS 39701
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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