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DSH490013 HALIFAX REGIONAL HOSPITAL (Terminated)
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Main Details
Name
HALIFAX REGIONAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH490013
Medicare Provider Number
490013
Additional Details
Current Program Status
Terminated
Registration Date
8/17/2020
Participating Start Date
3/15/2022
Participating Approval Date
8/27/2020
Last Recertification Date
9/8/2022
Termination Date
Termination Reason
10/1/2023
DSH percentage below statutory minimum
Contacts
Authorizing Official
Sentara Halifax Regional Hospital
Brian Keith Zwoyer, President
(434) 517-3196
Primary Contact
Sentara Halifax Regional Hospital
David Bryant Fitts, Pharmacy Manager
(434) 517-3312
Addresses
Street Address
2204 Wilborn Avenue
SOUTH BOSTON, VA 24592
Billing Address
Sentara Halifax Regional Hospital
6015 Poplar Hall Drive
Norfolk, VA 23502
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (10/1/2016), until terminated effective date: (7/1/2017), reinstatement effective date: (10/02/2020)
08/18/2020
8/25/16 participating as DSH entity type from 12/14/05 until terminated 10/1/13, participating as SCH entity type from 10/01/2013 until 10/1/16 when changed entity type back to DSH
08/25/2016
07/17/13-JM-review of the documentation provided by Halifax in support of their SCH applicatin and self-disclosure indicated that Halifax has been ineligible since 2012. 12/2/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %
07/17/2013
12/2/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %
12/14/2009
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