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DSH260113S MISSOURI DELTA MEDICAL CENTER (Active)
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Main Details
Name
MISSOURI DELTA MEDICAL CENTER
Subdivision Name
PORTAGEVILLE COMMUNITY CARE CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260113S
Medicare Provider Number
260113
Outpatient Facility Provider Number
268698
Additional Details
Current Program Status
Active
Registration Date
1/9/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/6/2015
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Missouri Delta Medical Center
JASON SCHRUMPF, CEO
(573) 472-7600
Primary Contact
Missouri Delta Medical Center
Christopher White, Director of Pharmacy
(573) 472-7450
Addresses
Street Address
204 EAST THIRD
PORTAGEVILLE, MO 63873
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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