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DSH260137C FREEMAN HEALTH SYSTEM (Terminated)
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Main Details
Name
FREEMAN HEALTH SYSTEM
Subdivision Name
Kidney Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260137C
Medicare Provider Number
260137
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/30/2006
Participating Start Date
9/15/2005
Participating Approval Date
11/30/2006
Last Recertification Date
8/6/2015
Termination Date
Termination Reason
4/1/2016
Site closure
Contacts
Authorizing Official
Freeman Health System
STEVE GRADDY, CFO
(417) 347-6678
Primary Contact
Freeman Health System
Jeff Thompson, Chief Clinical Officer
(417) 347-3563
Addresses
Street Address
932 EAST 34TH STREET
JOPLIN, MO 64804
Billing Address
Freeman Health System
1102 W. 32nd Street
Joplin, MO 64804
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/6/09 UPDATED ADDR (WAS 1102-A WEST 32ND STREET); 3/12/08-CHANGED ADDRESS (WAS 1111 MCINTOSH CIRCLE) AND ADDED KS,OK,AR MEDICAID #; 12/31/07 ADDED MED #; 7/5/07 REMOVED MED # (WAS 508364106); 10/25/05 - ADDR CHANGE (WAS 932 E 34TH)
03/06/2009
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