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DSH510046D PRINCETON COMMUNITY HOSPITAL (Terminated)
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Main Details
Name
PRINCETON COMMUNITY HOSPITAL
Subdivision Name
WVU Cancer Institute PCH Cancer Medicine - Hematology/Oncology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH510046D
Medicare Provider Number
510046
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/4/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/11/2024
Last Recertification Date
9/5/2024
Termination Date
Termination Reason
4/1/2025
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Princeton Community Hospital Association, Inc.
Diane Lynn Spencer, VP of Finance/CFO
(304) 487-7505
Primary Contact
Princeton Community Hospital
Daniel Paul Morrison, Director of Pharmacy
(304) 487-7564
Addresses
Street Address
122 Twelfth Street
Princeton, WV 24740
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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