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CAH141352-00 Jacksonville Memorial Hospital (Active)
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Main Details
Name
Jacksonville Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH141352-00
Medicare Provider Number
141352
Additional Details
Current Program Status
Active
Registration Date
7/6/2022
Participating Start Date
7/7/2022
Participating Approval Date
7/7/2022
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Memorial Health System
Michael Trevor Huffman, President and CEO
(217) 479-5523
Primary Contact
Jacksonville Memorial Hospital
Richard Atkins, Manager of Pharmacy
(217) 245-9541
Addresses
Street Address
1600 WEST WALNUT
JACKSONVILLE, IL 62650
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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