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DSH260195D CITIZENS MEMORIAL HOSPITAL DISTRICT (Active)
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Main Details
Name
CITIZENS MEMORIAL HOSPITAL DISTRICT
Subdivision Name
Stockton Family Medical Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260195D
Medicare Provider Number
260195
Outpatient Facility Provider Number
263977
Additional Details
Current Program Status
Active
Registration Date
11/29/2011
Participating Start Date
4/1/2022
Participating Approval Date
12/13/2011
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
Citizens Memorial Hospital
Renee Marie Meyer, Chief Financial Officer
(417) 328-6258
Primary Contact
Citizens Memorial Hospital District
Tim Wolters, Director of Reimbursement
(417) 328-7286
Addresses
Street Address
1521 South 3rd Street
Stockton, MO 65785
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/13/11 APPROVED DURING PHE IN MISSOURI
11/29/2011
April 2025
April 2025
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