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DSH010039 HUNTSVILLE HOSPITAL (Terminated)
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Main Details
Name
HUNTSVILLE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH010039
Medicare Provider Number
010039
Additional Details
Current Program Status
Terminated
Registration Date
1/10/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/25/2020
Last Recertification Date
9/2/2020
Termination Date
Termination Reason
12/1/2020
At request of covered entity
Contacts
Authorizing Official
Huntsville Hospital
Clinton Carter, CFO
(256) 265-8818
Primary Contact
Huntsville Hospital
Luona Wang, Business Manager of Pharmacy Services
(256) 265-6241
Addresses
Street Address
101 SIVLEY ROAD
HUNTSVILLE, AL 35801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (02/24/2010), until terminated effective date: (01/01/2016), reinstatement effective date: (04/01/2020).
01/15/2020
7/22/11 UPDATED PHYS ADD (WAS 101 SIVLEY ROAD ); 3/11/2011- ADDED NPI#; 7/28/10 BILL/SHIP TO ADDED - 2/24/2010-DOCUMENTS RECD TO CONFIRM ELIGIBLE DSH ADJ%; 11/16/11 - UPDATED SHIP TO(WAS HUNTSVILLE HOSPITAL 911 BIG COVE ROAD SE)
11/16/2011
7/22/11 UPDATED PHYS ADD (WAS 101 SIVLEY ROAD ); 3/11/2011- ADDED NPI#; 7/28/10 BILL/SHIP TO ADDED - 2/24/2010-DOCUMENTS RECD TO CONFIRM ELIGIBLE DSH ADJ%;
07/22/2011
3/11/2011- ADDED NPI#; 7/28/10 BILL/SHIP TO ADDED - 2/24/2010-DOCUMENTS RECD TO CONFIRM ELIGIBLE DSH ADJ%;
03/11/2011
April 2025
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