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DSH260070H PEMISCOT COUNTY MEMORIAL HOSPITAL (Active)
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Main Details
Name
PEMISCOT COUNTY MEMORIAL HOSPITAL
Subdivision Name
Bootheel Primary Care - Caruthersville
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260070H
Medicare Provider Number
260070
Outpatient Facility Provider Number
268626
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
1502 Ward Avenue
Caruthersville, MO 63830
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
12/24/2014
April 2025
April 2025
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