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DSH340069AP WAKEMED (Active)
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Main Details
Name
WAKEMED
Subdivision Name
Mobile Ambulance Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340069AP
Medicare Provider Number
340069
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2013
Participating Start Date
7/1/2016
Participating Approval Date
12/2/2013
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Wakemed
DONALD GINTZIG, President and CEO
(919) 350-8102
Primary Contact
WakeMed
Ethan Meadows, Business Manager
(919) 350-8192
Addresses
Street Address
900 Management Way
Garner, NC 27529
Billing Address
Mobile Ambulance Services
Attn: Accounts Payable
P. O. Box 14549
Raleigh, NC 27620
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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5/18/16 Participated starting 1/1/2014, terminated 7/1/2014. Reinstated 7/1/2016.
05/18/2016
June 2025
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