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CAH511304-01 Marietta Memorial Hospital of Tyler County, Inc. DBA Sistersville General Hospital (Active)
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Main Details
Name
Marietta Memorial Hospital of Tyler County, Inc. DBA Sistersville General Hospital
Subdivision Name
Sistersville Medical Center
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH511304-01
Medicare Provider Number
511304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
8/7/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/4/2012
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Marietta Memorial Hospital
Doug Full, Director of Finance
(740) 374-1698
Primary Contact
Marietta Memorial Hospital
David Layne, 340B Pharmacy Analyst
(606) 922-3796
Addresses
Street Address
100 Fair Street
Middlebourne, WV 26149
Billing Address
Sistersville General Hopsital
314 South Wells St
Sistersville, WV 26175
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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