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DSH510038N STONEWALL JACKSON MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
STONEWALL JACKSON MEMORIAL HOSPITAL
Subdivision Name
STONEWALL PEDIATRICS/MISTRY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH510038N
Medicare Provider Number
510038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/10/2015
Last Recertification Date
11/14/2017
Termination Date
Termination Reason
10/1/2018
Site closure
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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