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DSH510038K STONEWALL JACKSON MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
STONEWALL JACKSON MEMORIAL HOSPITAL
Subdivision Name
Brian Hornsby, D.O.
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH510038K
Medicare Provider Number
510038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/5/2015
Participating Start Date
4/1/2015
Participating Approval Date
2/9/2015
Last Recertification Date
9/4/2018
Termination Date
Termination Reason
10/1/2018
Failure to recertify
Contacts
Authorizing Official
Stonewall Jackson Memorial Hospital
Kevin Stalnaker, Chief Administrative Officer
(304) 269-8152
Primary Contact
Stonewall Jackson Memorial Hospital
John Edward Pope, Director of Pharmacy
(304) 269-8092
Addresses
Street Address
251 West Second Street
Suite 1
Weston, WV 26452
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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