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SCH260186-01 Lake Regional Health System (Terminated)
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Main Details
Name
Lake Regional Health System
Subdivision Name
Lake Regional Clinic - Macks Creek
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH260186-01
Medicare Provider Number
260186
Outpatient Facility Provider Number
268706
Additional Details
Current Program Status
Terminated
Registration Date
10/5/2016
Participating Start Date
1/1/2017
Participating Approval Date
12/15/2016
Last Recertification Date
8/15/2018
Termination Date
Termination Reason
7/1/2019
Site closure
Contacts
Authorizing Official
Lake Regional Health System
David W. Halsell, CFO
(573) 348-8388
Primary Contact
Lake Regional.com
Michael Dow, Director of Ancillary Services
(573) 348-8190
Addresses
Street Address
14298 W. US Hwy 54
Macks Creek, MO 65786
Billing Address
PO Box 1500
54 Hospital Drive
Osage Beach, MO 65065
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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