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DSH340014J 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 KERNERSVILLE MEDICAL CENTER CARDIAC NON-INVASIVE LAB
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340014J
Medicare Provider Number
340014
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/29/2011
Participating Start Date
1/1/2012
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
1750 KERNERSVILLE MEDICAL PARKWAY
KERNERSVILLE, NC 27284
Billing Address
KERNERSVILLE MEDICAL CENTER
1750 KERNERSVILLE MEDICAL PARKWAY
KERNERSVILLE, NC 27284
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/4/12 UPDATED SHIP AND BILL ADD (WAS 50 KERNERSVILLE MEDICAL CENTER BLVD)
04/04/2012
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