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CAH261307-00 GENERAL JOHN J. PERSHING MEMORIAL HOSPITAL (Active)
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Main Details
Name
GENERAL JOHN J. PERSHING MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH261307-00
Medicare Provider Number
261307
Additional Details
Current Program Status
Active
Registration Date
2/22/2011
Participating Start Date
4/1/2011
Participating Approval Date
3/8/2011
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Pershing Health System
Karla Clubine, CEO
(660) 258-1141
Primary Contact
GENERAL JOHN J. PERSHING MEMORIAL HOSPITAL
BRIAN CASEBOLT, DIRECTOR OF PHARMACY
(660) 258-1161
Addresses
Street Address
130 E. LOCKLING AVENUE
BROOKFIELD, MO 64628
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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