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DSH260137BL FREEMAN HEALTH SYSTEM (Terminated)
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Main Details
Name
FREEMAN HEALTH SYSTEM
Subdivision Name
FIRST CARE - First Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260137BL
Medicare Provider Number
260137
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/1/2019
Last Recertification Date
9/4/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Freeman Health System
STEVE GRADDY, CFO
(417) 347-6678
Primary Contact
Freeman Health System
Jeff Thompson, Chief Clinical Officer
(417) 347-3563
Addresses
Street Address
3202 MCINTOSH CIR
STE 103
JOPLIN, MO 64804-3686
Billing Address
Freeman Health System
1102 W 32nd St
Joplin, MO 64804
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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