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DSH260078C OZARKS MEDICAL CENTER (Terminated)
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Main Details
Name
OZARKS MEDICAL CENTER
Subdivision Name
SALEM FIRST CARE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260078C
Medicare Provider Number
260078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
6/3/2010
Participating Start Date
7/1/2010
Participating Approval Date
6/4/2010
Last Recertification Date
8/14/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Ozarks Medical Center
Nichole Cook, Vice President of Finance
(417) 256-9111 Ext: 6010
Primary Contact
MICHAEL GROSS, CFO
(417) 257-5837
Addresses
Street Address
172 HWY 62 EAST, SUITE 1
SALEM, AR 72554
Billing Address
SALEM FIRST CARE
PO BOX 369
SALEM, AR 72554
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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