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DSH340003G NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY (Terminated)
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Main Details
Name
NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY
Subdivision Name
SURRY SURGICAL ASSOCIATES
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH340003G
Medicare Provider Number
340003
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2014
Participating Start Date
7/1/2017
Participating Approval Date
6/11/2014
Last Recertification Date
9/5/2018
Termination Date
Termination Reason
4/1/2019
DSH percentage below statutory minimum
Contacts
Authorizing Official
Northern Hospital
Robin Hodgin, VP Patient Care Services
(336) 719-7019
Primary Contact
Northern Hospital of Surry County
DARRELL ESTES, DIRECTOR OF PHARMACY
(336) 719-7120
Addresses
Street Address
708 S. SOUTH STREET SUITE 100
MOUNT AIRY, NC 27030
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date (7/1/2014), until terminated effective date (7/1/2015), Reinstatement date effective (07/01/2017)
06/09/2017
May 2025
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