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DSH490007L SENTARA NORFOLK GENERAL HOSPITAL (Terminated)
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Main Details
Name
SENTARA NORFOLK GENERAL HOSPITAL
Subdivision Name
Sentara Fort Norfolk / Pain Management
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH490007L
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
8/31/2023
Termination Date
Termination Reason
1/1/2024
Site closure
Contacts
Authorizing Official
Sentara Norfolk General Hospital
Liisa K Ortegon, President
(757) 388-3240
Primary Contact
Sentara Norfolk General Hospital
Tim Jennings, VP Pharmacy
(757) 388-3443
Addresses
Street Address
301 Riverview Ave
Suite 202
Norfolk, VA 23510
Billing Address
Sentara Norfolk General Hospital
6015 Poplar Hall Drive
Norfolk, VA 23502
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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