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DSH340014L Forsyth Memorial Hospital, Inc d/b/a Novant Health Forsyth Medical Center (Terminated)
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Main Details
Name
Forsyth Memorial Hospital, Inc d/b/a Novant Health Forsyth Medical Center
Subdivision Name
NOVANT HEALTH OUTPATIENT WOUND CARE CENTER - KERNERSVILLE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340014L
Medicare Provider Number
340014
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/29/2011
Participating Start Date
10/1/2017
Participating Approval Date
12/13/2011
Last Recertification Date
9/6/2019
Termination Date
Termination Reason
7/7/2020
DSH percentage below statutory minimum
Contacts
Authorizing Official
Novant Health
Geoffrey Gardner, SVP Finance
(336) 718-2078
Primary Contact
Novant Health
Elizabeth Anne Corazzo, Manager Pharmacy 340B
(336) 277-0301
Addresses
Street Address
1710 KERNERSVILLE MEDICAL PKWY
Suite 220
KERNERSVILLE, NC 27284-7146
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/3/17 Participated starting 1/1/2012, terminated 7/1/2016. Reinstated 10/1/2017.
08/03/2017
4/4/12 UPDATE BILL AND SHIP ADD (WAS 0 KERNERSVILLE MEDICAL CENTER BLVD)
04/04/2012
April 2025
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