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DSH260070K PEMISCOT COUNTY MEMORIAL HOSPITAL (Active)
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Main Details
Name
PEMISCOT COUNTY MEMORIAL HOSPITAL
Subdivision Name
Pain Management - Injection Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260070K
Medicare Provider Number
260070
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2020
Participating Start Date
7/1/2020
Participating Approval Date
5/21/2020
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Pemiscot Memorial Health Systems
DAVID KETCHUM, CEO
(573) 359-3579
Primary Contact
PEMISCOT MEMORIAL HEALTH SYSTEMS
Loren Clifton, Pharmacy Technican
(573) 359-3612
Addresses
Street Address
225 North Hwy J
Hayti, MO 63851
Billing Address
Pemiscot Memorial Health Systems
PO BOX 489
Hayti, MO 63851
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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