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SCH490090-00 SOUTHSIDE COMMUNITY HOSPITAL (Terminated)
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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
Terminated
Registration Date
9/15/2022
Participating Start Date
9/21/2022
Participating Approval Date
9/21/2022
Last Recertification Date
9/5/2023
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Centra Health Inc.
Tabitha M. Culbertson, President, Lynchburg General &Virginia Baptist Hospitals
(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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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
April 2025
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