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CAH261302-01 MADISON MEDICAL CENTER (Terminated)
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Main Details
Name
MADISON MEDICAL CENTER
Subdivision Name
Arcadia Valley Family Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH261302-01
Medicare Provider Number
261302
Outpatient Facility Provider Number
268572
Additional Details
Current Program Status
Terminated
Registration Date
11/7/2011
Participating Start Date
12/14/2011
Participating Approval Date
12/14/2011
Last Recertification Date
8/20/2020
Termination Date
Termination Reason
1/1/2021
Site closure
Contacts
Authorizing Official
Madison Medical Center
Lisa Twidwell, CEO
(573) 783-1020 Ext: 3311
Primary Contact
Madison Medical Center
Allan R Sucharski, CFO
(573) 783-1070 Ext: 3346
Addresses
Street Address
200-600 St. Mary's Drive
Pilot Knob, MO 63663
Billing Address
Madison Medical Center
611 WEST MAIN STREET
FREDERICKTOWN, MO 63645
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/14/11 APPROVED DURING THE PHE IN MISSOURI
12/14/2011
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