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DSH260137X FREEMAN HEALTH SYSTEM (Terminated)
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Main Details
Name
FREEMAN HEALTH SYSTEM
Subdivision Name
ESGUERRA PEDIATRIC CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260137X
Medicare Provider Number
260137
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/5/2014
Last Recertification Date
8/19/2019
Termination Date
Termination Reason
10/1/2020
Site closure
Contacts
Authorizing Official
Freeman Health System
STEVE GRADDY, CFO
(417) 347-6678
Primary Contact
Freeman Health System
Jeff Thompson, Chief Clinical Officer
(417) 347-3563
Addresses
Street Address
702 E 34TH ST
SUITE 103
JOPLIN, MO 64804-3900
Billing Address
FREEMAN HEALTH SYSTEM
1102 W 32ND ST
JOPLIN, MO 64804
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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