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DSH490007K SENTARA NORFOLK GENERAL HOSPITAL (Terminated)
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Main Details
Name
SENTARA NORFOLK GENERAL HOSPITAL
Subdivision Name
Sentara PET Mobile / Radiology PET Mobile
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH490007K
Medicare Provider Number
490007
Outpatient Facility Provider Number
490007
Additional Details
Current Program Status
Terminated
Registration Date
7/9/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/16/2014
Last Recertification Date
8/30/2019
Termination Date
Termination Reason
10/1/2020
Site closure
Contacts
Authorizing Official
Sentara Norfolk General Hospital
Jessica Thompson Melton, Interim President
(757) 388-3420
Primary Contact
Sentara Norfolk General Hospital
Tim Jennings, VP Pharmacy
(757) 388-3443
Addresses
Street Address
5900 Lake Wright Drive
Norfolk, VA 23502
Billing Address
Sentara Norfolk General Hospital
600 Gresham Drive
Norfolk, VA 23507
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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