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SCH260097-22 WESTERN MISSOURI MEDICAL CENTER (Terminated)
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Main Details
Name
WESTERN MISSOURI MEDICAL CENTER
Subdivision Name
Western MO Specialty Services - Nephrology
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH260097-22
Medicare Provider Number
260097
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/26/2017
Last Recertification Date
8/18/2020
Termination Date
Termination Reason
10/1/2021
Other
Contacts
Authorizing Official
Western Missouri Medical Center
Dean Ohmart, Chief Financial Officer
(660) 262-7307
Primary Contact
Western Missouri Medical Center
Mary E Chapa, 340B Coordinator
(660) 262-7257
Addresses
Street Address
407 BURKARTH RD STE 302
WARRENSBURG, MO 64093-3101
Billing Address
Western Missouri Medical Center
PO Box 537
Warrensburg, MO 64093
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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