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DSH260078AA Ozarks Medical Center DBA Ozarks Healthcare (Terminated)
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Main Details
Name
Ozarks Medical Center DBA Ozarks Healthcare
Subdivision Name
Ozarks Healthcare Imaging-Radiation Therapy
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260078AA
Medicare Provider Number
260078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/6/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/12/2015
Last Recertification Date
9/3/2021
Termination Date
Termination Reason
7/1/2022
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Ozarks Medical Center dba Ozarks Healthcare
Nichole Cook, Vice President of Finance
(417) 256-9111 Ext: 6010
Primary Contact
Ozarks Medical Center DBA Ozarks Healthcare
Katie Mahan, Director of 340B and Specialty Pharmacy Services
(417) 505-7700
Addresses
Street Address
1111 Kentucky Avenue
West Plains, MO 65775
Billing Address
Ozarks Medical Center
PO Box 1100
West Plains, MO 65775
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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