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SCH490098-00 COMMUNITY MEMORIAL HOSPITAL (ToBeTerminated)
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Main Details
Name
COMMUNITY MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH490098-00
Medicare Provider Number
490098
Additional Details
Current Program Status
ToBeTerminated
Registration Date
1/6/2025
Participating Start Date
4/1/2025
Participating Approval Date
2/25/2025
Last Recertification Date
Termination Date
Termination Reason
7/1/2025
Change of covered entity type
Contacts
Authorizing Official
VCU Health System
Matthew Jenkins, Vice President, Chief Pharmacy Officer
(804) 628-8676
Primary Contact
Community Memorial Hospital
Ricky Clary, Director of Pharmacy
(434) 584-5115
Addresses
Street Address
1755 N MECKLENBURG AVENUE
SOUTH HILL, VA 23970
Billing Address
Community Memorial Hospital
1755 N Mecklenburg Avenue
PO Box 90
South Hill, VA 23970
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (04/01/2020) until terminated effective date: (04/01/2021); reinstatement effective date: (04/1/2025)
02/25/2025
Participating from effective date: (7/1/2013), until terminated effective date: (01/01/2018), reinstatement effective date: (04/01/2020)
02/28/2020
June 2025
June 2025
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