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DSH510082 SUMMERSVILLE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
SUMMERSVILLE MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH510082
Medicare Provider Number
510082
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2005
Participating Start Date
4/1/2017
Participating Approval Date
6/3/2005
Last Recertification Date
8/25/2015
Termination Date
Termination Reason
7/1/2017
Change of covered entity type
Contacts
Authorizing Official
Joe Barnes, CFO
(304) 872-8402
Primary Contact
Summersville Regional Medical Center
Robert Schaub, Director of Pharmacy
(304) 872-8437
Addresses
Street Address
400 FAIRVIEW HEIGHTS ROAD
SUMMERSVILLE, WV 26651
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2005; terminated 7/1/2016; reinstated on 4/1/2017. RURAL NEW ENTRY 7/1/05
03/15/2017
RURAL NEW ENTRY 7/1/05
07/01/2005
April 2025
April 2025
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