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DSH260141BZ University of Missouri Health Care (Terminated)
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Main Details
Name
University of Missouri Health Care
Subdivision Name
WCH PEDIATRIC URGENT CARE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260141BZ
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
8/29/2018
Termination Date
Termination Reason
7/1/2019
Site closure
Contacts
Authorizing Official
University of Missouri Health Care
Jonathan Curtright, CEO
(573) 884-8738
Primary Contact
University of Missouri Health Care
Jacob Simons, Pharmacy Business Director
(573) 884-4614
Addresses
Street Address
404 N. KEENE ST
COLUMBIA, MO 65201
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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