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DSH260017B PHELPS COUNTY REGIONAL MEDICAL CNTR (Active)
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Main Details
Name
PHELPS COUNTY REGIONAL MEDICAL CNTR
Subdivision Name
Ambulatory Surgery Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260017B
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
1050 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 7/1/2013, terminated 10/1/2020. Reinstated 3/2/2021.
03/02/2021
April 2025
April 2025
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