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DSH340014AX 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 Urology Partners - Baldwin
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340014AX
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
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
2010 Baldwin Lane
Winston-Salem, NC 27103-5846
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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