340B Drug Pricing Program Database
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DSH260078AC Ozarks Medical Center DBA Ozarks Healthcare (Terminated)
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Main Details
Name
Ozarks Medical Center DBA Ozarks Healthcare
Subdivision Name
Ozarks Healthcare Mammoth Spring
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260078AC
Medicare Provider Number
260078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/4/2023
Participating Start Date
4/1/2023
Participating Approval Date
2/9/2023
Last Recertification Date
8/15/2024
Termination Date
Termination Reason
4/1/2025
Site closure
Contacts
Authorizing Official
Ozarks Medical Center DBA Ozarks Healthcare
Lacey Carter, Chief Operating Officer
(417) 256-9111 Ext: 5968
Primary Contact
Ozarks Medical Center DBA Ozarks Healthcare
Katie Mahan, Director of 340B and Specialty Pharmacy Services
(417) 505-7700
Addresses
Street Address
260 Main Street
Mammoth Spring, AR 72554
Billing Address
Ozarks Medical Center DBA Ozarks Healthcare
P.O. Box 1100
West Plains, MO 65775
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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