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DSH260017Y PHELPS COUNTY REGIONAL MEDICAL CNTR (Active)
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Main Details
Name
PHELPS COUNTY REGIONAL MEDICAL CNTR
Subdivision Name
Phelps Health - Salem Family Medicine Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260017Y
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
1415 West Scenic Rivers Blvd.
Salem, MO 65560
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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