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DSH510030 DAVIS MEDICAL CENTER (Active)
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Main Details
Name
DAVIS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH510030
Medicare Provider Number
510030
Additional Details
Current Program Status
Active
Registration Date
9/4/2007
Participating Start Date
1/1/2005
Participating Approval Date
9/4/2007
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Davis Health System
William Lloyd Koch, Director of Financial Operations
(304) 637-3196
Primary Contact
Vandalia Health
Julie Beam, Pharmacy 340B Analyst and Integrity Coordinator
(304) 701-7932
Addresses
Street Address
812 Gorman Avenue
ELKINS, WV 26241
Billing Address
Davis Memorial Hospital
PO Box 1484
812 Gorman Avenue
Elkins, WV 26241
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/27/12 Revised NPI# (Was 0001394000)
03/27/2012
April 2025
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