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DSH260070F PEMISCOT COUNTY MEMORIAL HOSPITAL (Active)
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Main Details
Name
PEMISCOT COUNTY MEMORIAL HOSPITAL
Subdivision Name
BOOTHEEL PRIMARY CARE CLINIC-STEELE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260070F
Medicare Provider Number
260070
Outpatient Facility Provider Number
268628
Additional Details
Current Program Status
Active
Registration Date
12/17/2010
Participating Start Date
1/1/2015
Participating Approval Date
3/9/2011
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Pemiscot Memorial Health Systems
DAVID KETCHUM, CEO
(573) 359-3579
Primary Contact
PEMISCOT MEMORIAL HEALTH SYSTEMS
Loren Clifton, Pharmacy Technican
(573) 359-3612
Addresses
Street Address
213 SOUTH WALNUT STREET
STEELE, MO 63877-1714
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/24/14 CE reinstated effective 1/1/15; was participating from 4/1/2011 to 9/30/13; not participating from 10/1/2013 to 12/30/14 due to failure to recertify; 02/10/2012 Changed Sub name (was BOOTHEEL PRIMARY CARE CLINIC - HORNERSVILLE), addresses (was 207 BESSIE STREET HORNERSVILLE, MO 63855) added medicaid #. CE reported move to a diferent location via change request.
12/24/2014
02/10/2012 Changed Sub name (was BOOTHEEL PRIMARY CARE CLINIC - HORNERSVILLE), addresses (was 207 BESSIE STREET HORNERSVILLE, MO 63855) added medicaid #. CE reported move to a diferent location via change request.
02/10/2012
April 2025
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