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DSH340064A WILKES REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
WILKES REGIONAL MEDICAL CENTER
Subdivision Name
Wilkes Regional Dialysis Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH340064A
Medicare Provider Number
340064
Outpatient Facility Provider Number
342313
Additional Details
Current Program Status
Terminated
Registration Date
5/11/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/21/2012
Last Recertification Date
8/24/2016
Termination Date
Termination Reason
1/1/2018
Site closure
Contacts
Authorizing Official
Wilkes Regional Medical Center
Barry Christopher Wald, Director - Affiliate Finance
(336) 651-8510
Primary Contact
NORTH CAROLINA BAPTIST HOSPITAL
Martin Konopko, System Manager 340b
(336) 713-9418
Addresses
Street Address
1917A West Park Drive
North Wilkesboro, NC 28659
Billing Address
Wilkes Regional Medical Center
1370 West D Street
North Wilkesboro, NC 28659
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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