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RRC360147-12 MARIETTA MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
MARIETTA MEMORIAL HOSPITAL
Subdivision Name
Primary Care
Type
Rural Referral Center
Rural
Yes
340B ID
RRC360147-12
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
11/9/2017
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
Marietta Memorial Hospital
Joseph Hupp, SR Director of Finance / Interim CFO
(740) 374-1546
Primary Contact
Marietta Memorial Hospital
Doug Full, Director of Finance
(740) 374-1698
Addresses
Street Address
503 5TH ST
BEVERLY, OH 45715-8916
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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