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RRC360147-45 MARIETTA MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
MARIETTA MEMORIAL HOSPITAL
Subdivision Name
Department of General and Bariatric Surgery
Type
Rural Referral Center
Rural
Yes
340B ID
RRC360147-45
Medicare Provider Number
360147
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/3/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/20/2015
Last Recertification Date
8/10/2016
Termination Date
Termination Reason
10/1/2016
For-Profit conversion
Contacts
Authorizing Official
Marietta Memorial Hospital
Joseph Hupp, SR Director of Finance / Interim CFO
(740) 374-1546
Primary Contact
Marietta Memorial Hospital
Michael Clark, Director of Pharmacy
(740) 374-1720
Addresses
Street Address
400 Matthew Street
Suite 304
Marietta, OH 45750
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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