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RRC360147-17 MARIETTA MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
MARIETTA MEMORIAL HOSPITAL
Subdivision Name
Allergy and Immunology
Type
Rural Referral Center
Rural
Yes
340B ID
RRC360147-17
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
8/20/2018
Termination Date
Termination Reason
4/1/2019
Business decision by the Covered Entity
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
410 2ND ST
MARIETTA, OH 45750-2115
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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