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SCH260142-01 JOHN FITZGIBBON MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
JOHN FITZGIBBON MEMORIAL HOSPITAL
Subdivision Name
Grand River Medical Clinic
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH260142-01
Medicare Provider Number
260142
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/19/2019
Participating Start Date
10/1/2019
Participating Approval Date
8/12/2019
Last Recertification Date
Termination Date
Termination Reason
1/1/2020
Other
Contacts
Authorizing Official
John Fitzgibbon Memorial Hospital
Angy P. Littrell, President & CEO
(660) 831-3251
Primary Contact
John Fitzgibbon Memorial Hospital
Bruce Blalock, Vice President
(660) 831-3212
Addresses
Street Address
815 E. Broadway
Brunswick, MO 65236
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated 10/1/2017, terminated 1/1/2019. Reinstated 10/1/2019.
08/07/2019
8/3/17 7/26/17;Participating 1/1/2015 as SCH until terminated effective 10/1/2015, then participated as DSH 10/1/15 to 10/1/17, reinstated as SCH effective 10/1/2017.
08/03/2017
May 2025
May 2025
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