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SCH260017-02 PHELPS COUNTY REGIONAL MEDICAL CNTR (Terminated)
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Main Details
Name
PHELPS COUNTY REGIONAL MEDICAL CNTR
Subdivision Name
Phelps Health Ambulatory Surgery Center - Ambulatory Surgery
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH260017-02
Medicare Provider Number
260017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/24/2020
Participating Start Date
9/30/2020
Participating Approval Date
9/30/2020
Last Recertification Date
Termination Date
Termination Reason
3/2/2021
Other
Contacts
Authorizing Official
Phelps County Regional Medical Center
Jana Cook, Chief Financial Officer
(573) 458-7916
Primary Contact
Phelps County Regional Medical Center
KREIG Leland MOORE, DIRECTOR OF PHARMACY
(573) 458-7892
Addresses
Street Address
1050 West 10th Street
2nd Floor Medical Office Building
Rolla, MO 65401
Billing Address
Phelps Health
1000 West 10th Street
Rolla, MO 65401
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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