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RRC360147-46 MARIETTA MEMORIAL HOSPITAL (Active)
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Main Details
Name
MARIETTA MEMORIAL HOSPITAL
Subdivision Name
Department of Neurology
Type
Rural Referral Center
Rural
Yes
340B ID
RRC360147-46
Medicare Provider Number
360147
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/23/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/29/2020
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Marietta Memorial Hospital
Doug Full, Director of Finance
(740) 374-1698
Primary Contact
Marietta Memorial Hospital
David Layne, 340B Pharmacy Analyst
(606) 922-3796
Addresses
Street Address
400 Matthew Street
Suite 211
Marietta, OH 45750
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective start date (7/1/2015), until terminated effective date: (10/1/2018), reinstatement effective date: (10/01/2020).
07/29/2020
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