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CAH141305-15 Memorial Hospital Association (Active)
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Main Details
Name
Memorial Hospital Association
Subdivision Name
Memorial Hospital Association Medical Based Clinic-Cardio - Cardiology
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH141305-15
Medicare Provider Number
141305
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/10/2023
Participating Start Date
1/1/2024
Participating Approval Date
10/30/2023
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Memorial Hospital Assoication
Teresa Smith, CFO
(217) 357-8573
Primary Contact
Memorial Hospital
Ada Bair, CEO
(217) 357-8566
Addresses
Street Address
1450 North County 2050
Carthage, IL 62321
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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