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DSH260195AL CITIZENS MEMORIAL HOSPITAL DISTRICT (Active)
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Main Details
Name
CITIZENS MEMORIAL HOSPITAL DISTRICT
Subdivision Name
CMH Dermatology Clinic - CMH Dermatology Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260195AL
Medicare Provider Number
260195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/4/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/9/2024
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
Citizens Memorial Hospital
Renee Marie Meyer, Chief Financial Officer
(417) 328-6258
Primary Contact
Citizens Memorial Hospital District
Tim Wolters, Director of Reimbursement
(417) 328-7286
Addresses
Street Address
1125 N. Butterfield Road
Bolivar, MO 65613
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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