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DSH260070A PEMISCOT COUNTY MEMORIAL HOSPITAL (Active)
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Main Details
Name
PEMISCOT COUNTY MEMORIAL HOSPITAL
Subdivision Name
Pemiscot Primary Care (Hayti Clinic)
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260070A
Medicare Provider Number
260070
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
3/4/2008
Participating Start Date
1/1/2015
Participating Approval Date
3/4/2008
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Pemiscot Memorial Health Systems
DAVID KETCHUM, CEO
(573) 359-3579
Primary Contact
PEMISCOT MEMORIAL HEALTH SYSTEMS
Loren Clifton, Pharmacy Technican
(573) 359-3612
Addresses
Street Address
907 East Reed
Hayti, MO 63851
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/24/14 enrolled 4/1/08 thru 9/30/13, not enrolled 10/1/13 thru 12/31/14 due to failure to recertify, reinstated effective 1/1/15 based on on-line registration submitted in October 2014
12/24/2014
April 2025
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