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SCH260050-05 Mosaic Medical Center Maryville (Terminated)
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Main Details
Name
Mosaic Medical Center Maryville
Subdivision Name
Mosaic Family Care Savannah / OB/GYN
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH260050-05
Medicare Provider Number
260050
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/2/2015
Last Recertification Date
8/17/2018
Termination Date
Termination Reason
10/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
Heartland Regional Medical Center
Dwain Stilson, Chief Financial Officer
(816) 271-7070
Primary Contact
Heartland Regional Medical Center
Craig Gordon, Manager Pharmacy Strategic Sourcing
(816) 271-6069
Addresses
Street Address
301 E Price Street, Suite A
Savannah, MO 64485
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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