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DSH260070C PEMISCOT COUNTY MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
PEMISCOT COUNTY MEMORIAL HOSPITAL
Subdivision Name
Portageville Primary Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260070C
Medicare Provider Number
260070
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/4/2008
Participating Start Date
1/1/2015
Participating Approval Date
3/4/2008
Last Recertification Date
8/29/2019
Termination Date
Termination Reason
7/1/2020
Site closure
Contacts
Authorizing Official
Pemiscot County Memorial Hospital
Leigha Kristen Ward, Chief Financial Officer
(573) 359-3612
Primary Contact
Pemiscot Memorial Health Systems
DAVID KETCHUM, CEO
(573) 359-3579
Addresses
Street Address
314 East Main
Portageville, MO 63873
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/24/14 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
12/24/2014
April 2025
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