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DSH340127H GRANVILLE MEDICAL CENTER (Terminated)
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Main Details
Name
GRANVILLE MEDICAL CENTER
Subdivision Name
GRANVILLE SPECIALTY CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340127H
Medicare Provider Number
340127
Outpatient Facility Provider Number
340127
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/15/2014
Last Recertification Date
9/2/2016
Termination Date
Termination Reason
1/1/2018
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
103 PROFESSIONAL PARK
STE C
OXFORD, NC 27565-2581
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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