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DSH260017A PHELPS COUNTY REGIONAL MEDICAL CNTR (Active)
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Main Details
Name
PHELPS COUNTY REGIONAL MEDICAL CNTR
Subdivision Name
PHELPS HEALTH - ONCOLOGY SERVICES
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260017A
Medicare Provider Number
260017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
2/25/2021
Participating Start Date
3/2/2021
Participating Approval Date
3/2/2021
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Phelps County Regional Medical Center
Jana Cook, Chief Financial Officer
(573) 458-7916
Primary Contact
Phelps County Regional Medical Center
KREIG Leland MOORE, DIRECTOR OF PHARMACY
(573) 458-7892
Addresses
Street Address
1060 West 10th Street
Rolla, MO 65401
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2012, terminated 10/1/2020. Reinstated 3/2/2021.
03/02/2021
April 2025
April 2025
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