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DSH260070 PEMISCOT COUNTY MEMORIAL HOSPITAL (Active)
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Main Details
Name
PEMISCOT COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260070
Medicare Provider Number
260070
Additional Details
Current Program Status
Active
Registration Date
10/3/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/12/2014
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Pemiscot County Memorial Hospital
Kacy Howell, Pharmacist
(573) 359-6147
Primary Contact
PEMISCOT MEMORIAL HEALTH SYSTEMS
Loren Clifton, Pharmacy Technican
(573) 359-3612
Addresses
Street Address
946 East Reed
HAYTI, MO 63851
Billing Address
Pemiscot County Memorial Hospital
946 East Reed
Hayti, MO 63851
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/3/14;CE reinstated effective 1/1/15; was participating from 4/1/2008 to 9/30/13; not participating from 10/1/2013 to 12/30/14 due to failure to recertify.
12/12/2014
June 2025
June 2025
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