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DSH340127F GRANVILLE MEDICAL CENTER (Terminated)
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Main Details
Name
GRANVILLE MEDICAL CENTER
Subdivision Name
Stovall Medical Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340127F
Medicare Provider Number
340127
Outpatient Facility Provider Number
340127
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/15/2014
Last Recertification Date
9/5/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Granville Health System
Adam West McConnell, CEO
(919) 690-3402
Primary Contact
Granville Health System
Jeffery M. Armstrong, CFO
(919) 690-3402
Addresses
Street Address
100 Durham Street
Stovall, NC 27582
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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