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OZARKS MEDICAL CTR DBA OZARKS HEALTHCARE
DSH260078 Ozarks Medical Center DBA Ozarks Healthcare
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Covered Entity Details
Entity Name
Ozarks Medical Center DBA Ozarks Healthcare
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260078
Entity Address
1100 KENTUCKY AVENUE
WEST PLAINS, MO 65775-1100
Medicare Provider Number
260078
Participating Start Date
1/1/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OZARKS MEDICAL CTR DBA OZARKS HEALTHCARE
Pharmacy Address
1100 N KENTUCKY AVE
WEST PLAINS, MO 65775
Pharmacy Comments
Contract Details
Approval Date
2/27/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/23/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kim Thompson, CFO
(417) 256-9111 Ext: 6031
Contract Pharmacy Representative
Ozarks Medical Center
Kim Thompson, CFO
(417) 256-9111 Ext: 6031
Signed By Date
1/11/2013
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