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DSH450221 MOORE COUNTY HOSPITAL DISTRICT DBA MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
MOORE COUNTY HOSPITAL DISTRICT DBA MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450221
Medicare Provider Number
450221
Additional Details
Current Program Status
Terminated
Registration Date
7/16/2008
Participating Start Date
7/1/2009
Participating Approval Date
6/23/2009
Last Recertification Date
11/29/2017
Termination Date
Termination Reason
4/1/2018
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Moore County Hospital District
JEFF Ray TURNER, CEO
(806) 935-7171
Primary Contact
Moore County Hospital District
Ashleigh Dozier Wiswell, Chief Operations Officer
(806) 934-7802
Addresses
Street Address
224 EAST 2ND STREET
DUMAS, TX 79029
Billing Address
MOORE COUNTY HOSPITAL DISTRICT
224 EAST 2ND STREET
DUMAS, TX 79029
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/30/09 ADDED BILL TO;
04/29/2010
May 2025
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