340B Drug Pricing Program Database
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DSH260009A BOTHWELL REGIONAL HEALTH CENTER (Terminated)
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Main Details
Name
BOTHWELL REGIONAL HEALTH CENTER
Subdivision Name
BRHC Pain Clinic - Pain Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260009A
Medicare Provider Number
260009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2023
Participating Start Date
10/1/2023
Participating Approval Date
8/7/2023
Last Recertification Date
9/5/2024
Termination Date
Termination Reason
4/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Bothwell Regional Health Center
Steven R Davis, Chief Financial Officer
(660) 829-7790
Primary Contact
Bothwell Regional Health Center
Jill Renae Weller, 340B Program Coordinator
(660) 827-9492
Addresses
Street Address
1430 Thompson Blvd
Sedalia, MO 65301
Billing Address
Bothwell Regional Health Center
601 E 14th St
Sedalia, MO 65301
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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