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DSH340032A GASTON MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
GASTON MEMORIAL HOSPITAL
Subdivision Name
DAY RUN
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340032A
Medicare Provider Number
340032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/6/2007
Participating Start Date
1/1/2005
Participating Approval Date
9/6/2007
Last Recertification Date
8/28/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Caromont Regional Medical Center
David O’Connor, CFO
(704) 834-2127
Primary Contact
William Chan, Business Manager of Pharmacy
(704) 834-4021
Addresses
Street Address
2525 COURT DRIVE
GASTONIA, NC 28053
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/3/12 REMOVED MEDICAID # (WAS 3400032)
09/06/2007
April 2025
April 2025
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