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DSH360039D GENESIS HEALTHCARE SYSTEM (Terminated)
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Main Details
Name
GENESIS HEALTHCARE SYSTEM
Subdivision Name
GENESIS HEALTH CENTER NEW CONCORD
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360039D
Medicare Provider Number
360039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/10/2008
Participating Start Date
4/1/2008
Participating Approval Date
3/11/2008
Last Recertification Date
8/17/2016
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Genesis Healthcare System
Michael Norman, Chief Financial Officer
(740) 454-4773
Primary Contact
Genesis Healthcare System
Shona Carr, Pharmacy 340b Manager
(740) 455-4900
Addresses
Street Address
1 EAST MAIN ST.
NEW CONCORD, OH 43762
Billing Address
GENESIS HEALTHCARE SYSTEM
2800 MAPLE AVE
ZANESVILLE, OH 43701
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/13/12 REVISED MEDICAID# (WAS 2784509)
02/13/2012
2/13/12 REVISED NPI# (WAS 2784509)
02/13/2012
12/1/08- DOC RECD TO CONFIRM ELIG DSH ADJ %
01/29/2009
2/13/12 ADDED NPI #0364430
03/10/2008
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