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SCH260195-25 CITIZENS MEMORIAL HOSPITAL DISTRICT (Terminated)
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Main Details
Name
CITIZENS MEMORIAL HOSPITAL DISTRICT
Subdivision Name
CMH Urology Surgical Clinic - CMH Urology Surgical Clinic
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH260195-25
Medicare Provider Number
260195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/1/2021
Participating Start Date
11/1/2021
Participating Approval Date
11/1/2021
Last Recertification Date
Termination Date
Termination Reason
4/1/2022
Change of covered entity type
Contacts
Authorizing Official
Citizens Memorial Hospital
Renee Marie Meyer, Chief Financial Officer
(417) 328-6258
Primary Contact
Citizens Memorial Hospital District
Tim Wolters, Director of Reimbursement
(417) 328-7286
Addresses
Street Address
1155 West Parkview Street, Suite 2C
Bolivar, MO 65613
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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