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SCH260097-03 WESTERN MISSOURI MEDICAL CENTER (Terminated)
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Main Details
Name
WESTERN MISSOURI MEDICAL CENTER
Subdivision Name
Western Missouri Family Healthcare
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH260097-03
Medicare Provider Number
260097
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/25/2015
Last Recertification Date
8/28/2018
Termination Date
Termination Reason
1/1/2019
Site closure
Contacts
Authorizing Official
Western Missouri Medical Center
Dean Ohmart, Chief Financial Officer
(660) 262-7307
Primary Contact
Western Missouri Medical Center
Janis Hughes, Pharmacy Clinical Manager
(660) 262-7490
Addresses
Street Address
807 W. 2nd Street
Holden, MO 64040
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/25/15 CE reinstated effective 10/1/15, was participating from 10/1/13 to 6/30/15, not participating from 7/1/15 to 9/30/15 due to DSH% below statutory minimum
08/25/2015
April 2025
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