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DSH510058X CAMDEN-CLARK MEMORIAL HOSP (Terminated)
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Main Details
Name
CAMDEN-CLARK MEMORIAL HOSP
Subdivision Name
SOUTHGATE PRIMARY CARE - Primary Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH510058X
Medicare Provider Number
510058
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/28/2024
Last Recertification Date
Termination Date
Termination Reason
1/1/2025
Other
Contacts
Authorizing Official
Camden Clark Medical Center DBA Camden-Clark Memorial Hospital
Kyle Anthony Pierson, CFO
(304) 424-2202
Primary Contact
WVU Medicine
Barbra Sue May, Enterprise Manager, 340B Program
(304) 290-9830
Addresses
Street Address
2107 PIKE ST
PARKERSBURG, WV 26101-6973
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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