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DSH010091C GROVE HILL MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
GROVE HILL MEMORIAL HOSPITAL
Subdivision Name
COFFEEVILLE MEDICAL CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH010091C
Medicare Provider Number
010091
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
12/12/2007
Participating Start Date
1/1/2008
Participating Approval Date
12/12/2007
Last Recertification Date
9/10/2015
Termination Date
Termination Reason
10/1/2015
Failure to recertify
Contacts
Authorizing Official
Grove Hill Memorial Hospital
Kenneth Larrimore, COO
(251) 275-3191
Primary Contact
Grove Hill Memorial Hospital
Emily Steadham, Administrator
(251) 275-3191 Ext: 4004
Addresses
Street Address
12 LONG AVE
COFFEEVILLE, AL 36524
Billing Address
GROVE HILL MEMORIAL HOSPITAL
PO BOX 935
GROVE HILL, AL 36451
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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