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DSH260017S PHELPS COUNTY REGIONAL MEDICAL CNTR (Active)
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Main Details
Name
PHELPS COUNTY REGIONAL MEDICAL CNTR
Subdivision Name
PHELPS HEALTH - Phelps Health Heart and Vascular Center (Suite 500)
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260017S
Medicare Provider Number
260017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2024
Participating Start Date
10/1/2024
Participating Approval Date
8/13/2024
Last Recertification Date
Contacts
Authorizing Official
Phelps County Regional Medical Center
Jana Cook, Chief Financial Officer
(573) 458-7916
Primary Contact
Phelps County Regional Medical Center
KREIG Leland MOORE, DIRECTOR OF PHARMACY
(573) 458-7892
Addresses
Street Address
1050 W 10TH ST
ROLLA, MO 65401-2905
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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