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DSH260142D JOHN FITZGIBBON MEMORIAL HOSPITAL (Active)
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Main Details
Name
JOHN FITZGIBBON MEMORIAL HOSPITAL
Subdivision Name
JOHN FITZGIBBON HOSPITAL INC - Pilot Grove Medical Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260142D
Medicare Provider Number
260142
Outpatient Facility Provider Number
268790
Additional Details
Current Program Status
Active
Registration Date
10/4/2023
Participating Start Date
1/1/2024
Participating Approval Date
11/2/2023
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
John Fitzgibbon Memorial Hospital
Angy P. Littrell, President & CEO
(660) 831-3251
Primary Contact
John Fitzgibbon Memorial Hospital, Inc.
Cheryl Lynn Cunningham, Compliance Officer
(660) 831-3767
Addresses
Street Address
212 COLLEGE ST
PILOT GROVE MEDICAL CLINIC AT FITZG
PILOT GROVE, MO 65276-1005
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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