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DSH510038M STONEWALL JACKSON MEMORIAL HOSPITAL (Active)
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Main Details
Name
STONEWALL JACKSON MEMORIAL HOSPITAL
Subdivision Name
Mon Health Pulmonology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH510038M
Medicare Provider Number
510038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/1/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/2/2018
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Vandalia Health
Clyde Richard Scherich, VP of Finance
(304) 598-1204
Primary Contact
Mon Health Stonewall Jackson memorial Hospital
Joe P Second, Sr Dir Operations
(304) 269-8149
Addresses
Street Address
29 Hospital Plaza, Suite B
Suite B
Weston, WV 26452
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date (4/1/2015) until terminated effective date (10/01/2018), reinstatement effective date (01/01/2019)
10/02/2018
June 2025
June 2025
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