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DSH510038G STONEWALL JACKSON MEMORIAL HOSPITAL (Active)
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Main Details
Name
STONEWALL JACKSON MEMORIAL HOSPITAL
Subdivision Name
Mon Health Primary Care - Weston
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH510038G
Medicare Provider Number
510038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/1/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/3/2018
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Vandalia Health
Clyde Richard Scherich, VP of Finance
(304) 598-1204
Primary Contact
Mon Health Stonewall Jackson memorial Hospital
Joe P Second, Sr Dir Operations
(304) 269-8149
Addresses
Street Address
456 Market Place Mall C
Weston, WV 26452
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date (01/01/2013) until terminated effective date (10/01/2018), reinstatement effective date (01/01/2019)
10/02/2018
April 2025
April 2025
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