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DSH340014 Forsyth Memorial Hospital, Inc d/b/a Novant Health Forsyth Medical Center (Terminated)
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Main Details
Name
Forsyth Memorial Hospital, Inc d/b/a Novant Health Forsyth Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340014
Medicare Provider Number
340014
Additional Details
Current Program Status
Terminated
Registration Date
6/6/2007
Participating Start Date
7/1/2007
Participating Approval Date
6/11/2007
Last Recertification Date
9/6/2019
Termination Date
Termination Reason
7/7/2020
DSH percentage below statutory minimum
Contacts
Authorizing Official
Novant Health
Geoffrey Gardner, SVP Finance
(336) 718-2078
Primary Contact
Novant Health
Elizabeth Anne Corazzo, Manager Pharmacy 340B
(336) 277-0301
Addresses
Street Address
3333 SILAS CREEK PARKWAY
WINSTON-SALEM, NC 27103-3013
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Forsyth Memorial Hospital transitioned from a DSH to an RRC on 7/7/2020
07/30/2020
4/29/08- ADDED MEDICAID # 3400014; 8/30/07- DOCUMENTATION SUBMITTED TO CONFIRM ELIGIBLE DSH ADJUSTMENT PERCENTAGE
04/29/2008
April 2025
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