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CAH261305-00 PUTNAM COUNTY MEMORIAL HOSPITAL (Active)
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Main Details
Name
PUTNAM COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH261305-00
Medicare Provider Number
261305
Additional Details
Current Program Status
Active
Registration Date
1/5/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/16/2018
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Putnam County Memorial Hospital
Gayle Pickens, CEO
(660) 947-2411 Ext: 2915
Primary Contact
Putnam County Memorial Hospital
Brianna Stamm, Director of Pharmacy
(660) 947-9245
Addresses
Street Address
1926 OAK STREET
UNIONVILLE, MO 63565
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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initial start 8/19/2010, Termination date 1/1/2018, reinstate 4/1/2018
01/08/2018
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