340B Drug Pricing Program Database
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DSH010024E JACKSON HOSPITAL AND CLINIC INC (Active)
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Main Details
Name
JACKSON HOSPITAL AND CLINIC INC
Subdivision Name
JACKSON OBSTETRICS & GYNECOLOGY - OBSTETRICS & GYNECOLOGY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH010024E
Medicare Provider Number
010024
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
8/31/2022
Participating Start Date
9/7/2022
Participating Approval Date
9/7/2022
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Jackson Hospital and Clinics
Thomas Hudson Cobb, Director of Pharmacy
(334) 293-8806
Primary Contact
Jackson Hospital & Clinic, Inc.
Ashley Cherie Forbus, 340B Program Manager
(334) 293-8788
Addresses
Street Address
1758 Park Place
301, 201
Montgomery, AL 36106
Billing Address
Jackson Hospital and clinic
1725 Pine Street
Montgomery, AL 36106
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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