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DSH260142A JOHN FITZGIBBON MEMORIAL HOSPITAL (Active)
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Main Details
Name
JOHN FITZGIBBON MEMORIAL HOSPITAL
Subdivision Name
Akeman-McBurney Medical Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260142A
Medicare Provider Number
260142
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/21/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/23/2019
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
John Fitzgibbon Memorial Hospital
Angy P. Littrell, President & CEO
(660) 831-3251
Primary Contact
John Fitzgibbon Memorial Hospital, Inc.
Cheryl Lynn Cunningham, Compliance Officer
(660) 831-3767
Addresses
Street Address
420 W. Front St.
Slater, MO 65349-1328
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2019, terminated 10/1/2019. Reinstated 1/1/2020.
10/22/2019
Initial start 10/1/2015, Termination 10/1/2017, Reinstate 1/1/2019
10/18/2018
8/21/15 Participated starting 1-1-2010, terminated 10-1-2014 through 9-30-15 due to the DSH percentage below statutory minimum, reinstated based on new registration submitted in July 2015
08/21/2015
10/21/14 Provider # temporarily removed to facility re-registration as a different entity type
10/22/2014
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