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RRC260175-00 GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT (Terminated)
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Main Details
Name
GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC260175-00
Medicare Provider Number
260175
Additional Details
Current Program Status
Terminated
Registration Date
9/29/2010
Participating Start Date
9/29/2010
Participating Approval Date
9/29/2010
Last Recertification Date
8/31/2020
Termination Date
Termination Reason
10/1/2021
Change of covered entity type
Contacts
Authorizing Official
Golden Valley Memorial Healthcare
Tammy Nadler, CFO
(660) 890-7105
Primary Contact
Golden Valley Memorial Healthcare
Melanie Maham, 340B Coordinator
(660) 890-7353
Addresses
Street Address
1600 NORTH SECOND STREET
CLINTON, MO 64735
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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9/15/2010 -DOC RECEIVED TO CONFIRM ELIG DSH ADJ %
09/29/2010
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