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DSH360039B GENESIS HEALTHCARE SYSTEM (Terminated)
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Main Details
Name
GENESIS HEALTHCARE SYSTEM
Subdivision Name
GOOD SAMARITAN HOSPITAL
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360039B
Medicare Provider Number
360039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/23/2007
Participating Start Date
7/1/2007
Participating Approval Date
5/24/2007
Last Recertification Date
8/28/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Genesis Healthcare System
Michael Norman, Chief Financial Officer
(740) 454-4773
Primary Contact
Genesis Healthcare System
Shona Carr, Pharmacy 340b Manager
(740) 455-4900
Addresses
Street Address
800 FOREST AVE.
ZANESVILLE, OH 43701-1406
Billing Address
GENESIS HEALTHCARE SYSTEM
2800 MAPLE AVE
ZANESVILLE, OH 43701
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/13/12 ADDED MEDICAID# (WAS 364430)
02/13/2012
12/1/08- DOC RECD TO CONFIRM ELIG DSH ADJ %
01/29/2009
2/13/12 ADDED NPI #0364430
05/23/2007
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