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CAH361302-02 TRINITY HOSPITAL TWIN CITY (Active)
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Main Details
Name
TRINITY HOSPITAL TWIN CITY
Subdivision Name
TRINITY MEDICAL GROUP / Surgical Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH361302-02
Medicare Provider Number
361302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/2/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/19/2014
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Trinity Health System
Dave Werkin, CFO
(740) 264-8695
Primary Contact
Trinity Hospital Twin CIty
Eric Durbin, Director of Pharmacy
(740) 922-7467
Addresses
Street Address
340 OXFORD STREET
Suite 200
DOVER, OH 44622-1966
Billing Address
Trinity Hospital Twin City
PO BOX 2400
PHOENIX, AZ 85002-6000
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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