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CAH141343-04 CRAWFORD HOSPITAL DISTRICT D/B/A CRAWFORD MEMORIAL HOSPITAL (Active)
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Main Details
Name
CRAWFORD HOSPITAL DISTRICT D/B/A CRAWFORD MEMORIAL HOSPITAL
Subdivision Name
CRAWFORD HOSPITAL DISTRICT - Med Center Rural Health Clinic IV
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH141343-04
Medicare Provider Number
141343
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/1/2022
Participating Start Date
7/1/2022
Participating Approval Date
4/13/2022
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Crawford Memorial Hospital
MITZI MARTIN, BOARD VICE CHAIR
(618) 544-3131 Ext: 5123
Primary Contact
Crawford Memorial Hospital
Blake Potts, Director of Pharmacy
(618) 544-3131 Ext: 5380
Addresses
Street Address
1000 N ALLEN ST
ROBINSON, IL 62454-1114
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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