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DSH260195P CITIZENS MEMORIAL HOSPITAL DISTRICT (Active)
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Main Details
Name
CITIZENS MEMORIAL HOSPITAL DISTRICT
Subdivision Name
Infusion/Medical Oncology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260195P
Medicare Provider Number
260195
Outpatient Facility Provider Number
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
1155 West Parkview Street, Suite 2M
Bolivar, MO 65613
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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