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CAH261337-01 Missouri Baptist Hospital of Sullivan, DBA, Missouri Baptist Sullivan Hospital (Active)
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Main Details
Name
Missouri Baptist Hospital of Sullivan, DBA, Missouri Baptist Sullivan Hospital
Subdivision Name
Bourbon Medical Office
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH261337-01
Medicare Provider Number
261337
Outpatient Facility Provider Number
268527
Additional Details
Current Program Status
Active
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
8/28/2014
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
MBSH
Lisa Lynne Lochner, President
(573) 468-1285 Ext: 5734681345
Primary Contact
MBSH
Louis Ettinger, Manager, Pharmacy
(573) 468-1312 Ext: 1312
Addresses
Street Address
240 College St.
Bourbon, MO 65441
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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