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CAH261328-04 NORTHWEST MEDICAL CENTER ASSOCIATION, INC. (Terminated)
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Main Details
Name
NORTHWEST MEDICAL CENTER ASSOCIATION, INC.
Subdivision Name
NORTHWEST MEDICAL CENTER-ALBANY CLINIC WEST
Type
Critical Access Hospital
Rural
No
340B ID
CAH261328-04
Medicare Provider Number
261328
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/23/2010
Participating Start Date
9/27/2010
Participating Approval Date
9/27/2010
Last Recertification Date
8/22/2018
Termination Date
Termination Reason
10/1/2019
Site closure
Contacts
Authorizing Official
Northwest Medical Center
JON David DOOLITTLE, PRESIDENT & CEO
(660) 726-3941 Ext: 1177
Primary Contact
Heartland Regional Medical Center
Craig Gordon, Manager Pharmacy Strategic Sourcing
(816) 271-6069
Addresses
Street Address
402 E. US HWY 136
ALBANY, MO 64402
Billing Address
NORTHWEST MEDICAL CENTER ASSOCIATION, INC.
705 N. COLLEGE
ALBANY, MO 64402
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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