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CAH361331-01 FAYETTE COUNTY MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
FAYETTE COUNTY MEMORIAL HOSPITAL
Subdivision Name
Fayette Rural Health Clinic 1
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH361331-01
Medicare Provider Number
361331
Outpatient Facility Provider Number
363982
Additional Details
Current Program Status
Terminated
Registration Date
2/29/2012
Participating Start Date
4/1/2012
Participating Approval Date
3/30/2012
Last Recertification Date
8/11/2016
Termination Date
Termination Reason
10/1/2017
Site closure
Contacts
Authorizing Official
Fayette County Memorial Hospital
Trent Lemle, CFO
(740) 333-2798
Primary Contact
Fayette County Memorial Hospital
Laura Rowe, Director of Pharmacy
(740) 333-2901
Addresses
Street Address
1450 Columbus Ave.
MAB 1 Suite 103
Washington Court House, OH 43160
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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03/20/2014: Termination recorded in error; site remained continuously eligible from participation start date.
03/31/2014
June 2025
June 2025
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