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DSH340014Z 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 Gateway Family Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340014Z
Medicare Provider Number
340014
Outpatient Facility Provider Number
340014
Additional Details
Current Program Status
Terminated
Registration Date
5/31/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/26/2012
Last Recertification Date
8/31/2018
Termination Date
Termination Reason
10/1/2019
Hospital Outpatient facility no longer eligible
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
390 Salem Avenue
Winston-Salem, NC 27101-5861
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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