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DSH140185H MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
MEMORIAL HOSPITAL
Subdivision Name
MHE CT - CT Scan
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140185H
Medicare Provider Number
140185
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2022
Participating Start Date
10/1/2022
Participating Approval Date
8/4/2022
Last Recertification Date
Termination Date
Termination Reason
7/1/2023
DSH percentage below statutory minimum
Contacts
Authorizing Official
Memorial Hospital
Michael McManus, President
(618) 257-5642
Primary Contact
Memorial Hospital
Ryan Birk, Director of Pharmacy
(618) 606-0210
Addresses
Street Address
1404 Cross St
Shiloh, IL 62269
Billing Address
BJC Healthcare
4249 Clayton Avenue
310
St. Louis, MO 63110
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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