340B Drug Pricing Program Database
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CAH261337-00 Missouri Baptist Hospital of Sullivan, DBA, Missouri Baptist Sullivan Hospital (Active)
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Main Details
Name
Missouri Baptist Hospital of Sullivan, DBA, Missouri Baptist Sullivan Hospital
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH261337-00
Medicare Provider Number
261337
Additional Details
Current Program Status
Active
Registration Date
10/11/2012
Participating Start Date
1/1/2013
Participating Approval Date
10/19/2012
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
MBSH
Lisa Lynne Lochner, President
(573) 468-1285 Ext: 5734681345
Primary Contact
MBSH
Louis Ettinger, Manager, Pharmacy
(573) 468-1312 Ext: 1312
Addresses
Street Address
751 Sappington Bridge Road
Sullivan, MO 63080
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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10/19/12 Originally enrolled in 340B Program as a DSH Hospital with 340B ID DSH260115
10/19/2012
June 2025
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