340B Drug Pricing Program Database
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DSH260175 GOLDEN VALLEY MEMORIAL HOSPITAL (Active)
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Main Details
Name
GOLDEN VALLEY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260175
Medicare Provider Number
260175
Additional Details
Current Program Status
Active
Registration Date
7/14/2021
Participating Start Date
10/1/2021
Participating Approval Date
8/9/2021
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Golden Valley Memorial Healthcare
Tammy Nadler, CFO
(660) 890-7105
Primary Contact
Golden Valley Memorial Healthcare
Melanie Maham, 340B Coordinator
(660) 890-7353
Addresses
Street Address
1600 NORTH SECOND
CLINTON, MO 64735-1192
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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