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DSH340032D GASTON MEMORIAL HOSPITAL (Active)
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Main Details
Name
GASTON MEMORIAL HOSPITAL
Subdivision Name
CaroMont Outpatient Surgery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340032D
Medicare Provider Number
340032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2024
Participating Start Date
1/1/2025
Participating Approval Date
11/19/2024
Last Recertification Date
Contacts
Authorizing Official
Caromont Regional Medical Center
David O’Connor, CFO
(704) 834-2127
Primary Contact
CaroMont Regional Medical Center
Mark Chaparro, Pharmacy Director
(704) 834-2239
Addresses
Street Address
2545 COURT DRIVE
GASTONIA, NC 28053
Billing Address
Gaston Memorial Hospital
Po Box 1747
Gastonia, NC 28053
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 3/15/22; Terminated 1/1/24; Reinstated 1/1/2025.
11/18/2024
4/3/12 REMOVED MEDICAID # (WAS 3400032); 1/13/06 UPDATED ADDR (WAS 2545 COURT DRIVE)
09/06/2007
1/13/06 UPDATED ADDR (WAS 2545 COURT DRIVE)
09/06/2007
April 2025
April 2025
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