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DSH360039E GENESIS HEALTHCARE SYSTEM (Terminated)
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Main Details
Name
GENESIS HEALTHCARE SYSTEM
Subdivision Name
GENESIS HEALTHCARE FIRST CARE NORTH
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH360039E
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
4/1/2017
For-Profit conversion
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
2800 MAPLE AVE.
ZANESVILLE, OH 43701
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/13/12 REVISED MEDICAID# (WAS 0597537)
02/13/2012
2/13/12 REVISED NPI# (WAS 0597537)
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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