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SCH260006-40 HEARTLAND REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
HEARTLAND REGIONAL MEDICAL CENTER
Subdivision Name
Heartland Vein Clinic
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH260006-40
Medicare Provider Number
260006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/6/2014
Participating Start Date
4/1/2014
Participating Approval Date
2/18/2014
Last Recertification Date
8/26/2019
Termination Date
Termination Reason
7/1/2020
Change of covered entity type
Contacts
Authorizing Official
Heartland Regional Medical Center
Dwain Stilson, Chief Financial Officer
(816) 271-7070
Primary Contact
Heartland Regional Medical Center
Craig Gordon, Manager Pharmacy Strategic Sourcing
(816) 271-6069
Addresses
Street Address
802 North Riverside Rd
Suite 225
St. Joseph, MO 64507
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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