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DSH260195Y CITIZENS MEMORIAL HOSPITAL DISTRICT (Active)
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Main Details
Name
CITIZENS MEMORIAL HOSPITAL DISTRICT
Subdivision Name
CMH Infectious Disease Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260195Y
Medicare Provider Number
260195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2014
Participating Start Date
4/1/2022
Participating Approval Date
12/9/2014
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
Citizens Memorial Hospital
Renee Marie Meyer, Chief Financial Officer
(417) 328-6258
Primary Contact
Citizens Memorial Hospital District
Tim Wolters, Director of Reimbursement
(417) 328-7286
Addresses
Street Address
1155 West Parkview Street, Suite 1F
Bolivar, MO 65613
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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