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DSH260141DF University of Missouri Health Care (Terminated)
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Main Details
Name
University of Missouri Health Care
Subdivision Name
FAMILY MEDICINE - BOONVILLE - Family Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260141DF
Medicare Provider Number
260141
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2022
Participating Start Date
4/1/2022
Participating Approval Date
3/1/2022
Last Recertification Date
8/17/2023
Termination Date
Termination Reason
7/1/2024
Site closure
Contacts
Authorizing Official
University of Missouri Health Care
KERI SIMON, Chief Operating Officer, Hospital Services
(573) 882-8359
Primary Contact
University of Missouri Health Care
Jacob Simons, Pharmacy Business Director
(573) 884-4614
Addresses
Street Address
102 ISLE OF CAPRI BLVD
BOONVILLE, MO 65233-1124
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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