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DSH260141AQ University of Missouri Health Care (Terminated)
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Main Details
Name
University of Missouri Health Care
Subdivision Name
WCH Outpatient Pediatric SLP
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260141AQ
Medicare Provider Number
260141
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
6/15/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/28/2012
Last Recertification Date
9/10/2014
Termination Date
Termination Reason
7/1/2015
Site closure
Contacts
Authorizing Official
University of Missouri Health Care
Jonathan Curtright, CEO
(573) 884-8738
Primary Contact
University of Missouri Health Care
David Wolfrath, Pharmacy Manager
(573) 882-8700
Addresses
Street Address
500 N. Keene St.
Ste. 401
Columbia, MO 65201
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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