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DSH260142 JOHN FITZGIBBON MEMORIAL HOSPITAL (Active)
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Main Details
Name
JOHN FITZGIBBON MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260142
Medicare Provider Number
260142
Additional Details
Current Program Status
Active
Registration Date
10/15/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/21/2019
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
John Fitzgibbon Memorial Hospital
Angy P. Littrell, President & CEO
(660) 831-3251
Primary Contact
John Fitzgibbon Memorial Hospital, Inc.
Cheryl Lynn Cunningham, Compliance Officer
(660) 831-3767
Addresses
Street Address
2305 SOUTH HIGHWAY 65
MARSHALL, MO 65340
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2019, terminated 10/1/2019. Reinstated 1/1/2020.
10/21/2019
The Office of Pharmacy Affairs recognizes that any Contract Pharmacy for DSH260142 with a termination date of 7/19/2019 is active until 10/1/2019.
09/17/2019
Initial start 10/1/2015, Termination 10/1/2017, Reinstate 1/1/2019
10/18/2018
8/14/15 Participated starting 1-1-2010, terminated 10-1-2014 through 9-30-15 due to the DSH percentage below statutory minimum, reinstated based on new registration submitted in July 2015
08/14/2015
10/21/14 Provider # temporarily removed to facility re-registration as a different entity type. 12/15/09 DOC. RECD. TO CONFIRM DSH ADJ. %.
10/22/2014
12/15/09 DOC. RECD. TO CONFIRM DSH ADJ. %.
01/21/2010
April 2025
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