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DSH260141BB University of Missouri Health Care (Terminated)
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Main Details
Name
University of Missouri Health Care
Subdivision Name
PAIN CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260141BB
Medicare Provider Number
260141
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/13/2013
Last Recertification Date
8/24/2015
Termination Date
Termination Reason
10/1/2015
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
3211 S. Providence
Bldg. C
COLUMBIA, MO 65203
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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