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SCH260186-09 Lake Regional Health System (Active)
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Main Details
Name
Lake Regional Health System
Subdivision Name
Lake Regional Clinic - Lebanon - Primary Care Clinic
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH260186-09
Medicare Provider Number
260186
Outpatient Facility Provider Number
268785
Additional Details
Current Program Status
Active
Registration Date
10/11/2022
Participating Start Date
1/1/2023
Participating Approval Date
11/23/2022
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Lake Regional Health System
Paula Littleton, CFO
(573) 348-8388
Primary Contact
Lake Regional Health System
Tony Kauten, Pharmacy Manager
(573) 348-8763
Addresses
Street Address
411 W. Elm St.
Lebanon, MO 65536
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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