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RRC360147-09 MARIETTA MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
MARIETTA MEMORIAL HOSPITAL
Subdivision Name
Internal Medicine
Type
Rural Referral Center
Rural
Yes
340B ID
RRC360147-09
Medicare Provider Number
360147
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/1/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/7/2014
Last Recertification Date
8/19/2020
Termination Date
Termination Reason
7/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Marietta Memorial Hospital
Doug Full, Director of Finance
(740) 374-1698
Primary Contact
Marietta Memorial Hospital
David Layne, 340B Pharmacy Analyst
(606) 922-3796
Addresses
Street Address
807 FARSON STREET
SUITE 201-C
BELPRE, OH 45714-1009
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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