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DSH510029G Thomas Memorial Hospital (Terminated)
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Main Details
Name
Thomas Memorial Hospital
Subdivision Name
Home Health Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH510029G
Medicare Provider Number
510029
Outpatient Facility Provider Number
517072
Additional Details
Current Program Status
Terminated
Registration Date
4/7/2014
Participating Start Date
7/1/2014
Participating Approval Date
6/10/2014
Last Recertification Date
9/1/2016
Termination Date
Termination Reason
1/1/2017
Site closure
Contacts
Authorizing Official
Thomas Memorial Hospital
Brian Ulery, Chief Operating Officer
(304) 766-3445
Primary Contact
Thomas Health
Brian L Ulery, Chief Operating Officer (COO)
(304) 766-3445
Addresses
Street Address
4825 MacCorkle Avenue, SW
South Charleston, WV 25309
Billing Address
Thomas Memorial Hospital
4605 MacCorkle Avenue, SW
South Charleston, WV 25309
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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