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DSH260113M MISSOURI DELTA MEDICAL CENTER (Terminated)
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Main Details
Name
MISSOURI DELTA MEDICAL CENTER
Subdivision Name
MISSOURI DELTA PHYSICIAN SERVICES SURGEONS
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260113M
Medicare Provider Number
260113
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/9/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/6/2015
Last Recertification Date
8/22/2021
Termination Date
Termination Reason
10/1/2022
Other
Contacts
Authorizing Official
Missouri Delta Medical Center
JASON SCHRUMPF, CEO
(573) 472-7600
Primary Contact
Missouri Delta Medical Center
Ryan Parker, Director of Pharmacy
(573) 472-7450
Addresses
Street Address
1015 North Main
SIKESTON, MO 63801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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