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SCH490090-00 SOUTHSIDE COMMUNITY HOSPITAL (Approved)
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Main Details
Name
SOUTHSIDE COMMUNITY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH490090-00
Medicare Provider Number
490090
Additional Details
Current Program Status
Approved
Registration Date
4/14/2025
Participating Start Date
7/1/2025
Participating Approval Date
5/28/2025
Last Recertification Date
Contacts
Authorizing Official
Centra Health, Inc.
James A. Frenchik, President Centra Health Lynchburg Region
(434) 200-3014
Primary Contact
Centra Health Inc
Cynthia W. Mann, Pharmacy Purchasing Manager
(434) 200-7297
Addresses
Street Address
800 OAK STREET
FARMVILLE, VA 23901
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 9/21/2022; Terminated 10/1/2023; Reinstated 7/1/2025.
05/28/2025
Participating from effective date: (04/01/2011) until terminated effective date: (10/29/2021), reinstatement effective date: (09/21/22)
09/21/2022
7/22/11 removed NPI(1518952761);3/3/11 REC. DOCS VERIFYING DSH%
07/22/2011
3/3/11 REC. DOCS VERIFYING DSH%
03/07/2011
June 2025
June 2025
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