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MD CLINICS, LLC
CAH191317-00 JACKSON PARISH HOSPITAL
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Covered Entity Details
Entity Name
JACKSON PARISH HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191317-00
Entity Address
165 BEECH SPRINGS ROAD
JONESBORO, LA 71251
Medicare Provider Number
191317
Participating Start Date
10/1/2018
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
MD CLINICS, LLC
Pharmacy Address
10600 INDUSTRIAL DR
MINDEN, LA 71055-5105
Pharmacy Comments
Contract Details
Approval Date
1/18/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Morgan, CEO
(318) 259-4435
Contract Pharmacy Representative
MD Clinicis, LLC
Renee DeMoss, Practice Administrator
(318) 599-4363
Signed By Date
1/18/2021
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