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CAH141353-00 Iroquois Memorial Hospital (Active)
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Main Details
Name
Iroquois Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH141353-00
Medicare Provider Number
141353
Additional Details
Current Program Status
Active
Registration Date
10/13/2023
Participating Start Date
1/1/2024
Participating Approval Date
11/14/2023
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME
Michael Tilstra, CEO
(815) 432-7777
Primary Contact
IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME
MICHAEL A SANDSMARK, PHARMACIST
(815) 432-7746
Addresses
Street Address
200 E. Fairman Ave.
Watseka, IL 60970
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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