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DSH340014CF FORSYTH MEMORIAL HOSPITAL INC (Terminated)
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Main Details
Name
FORSYTH MEMORIAL HOSPITAL INC
Subdivision Name
WINSTON-SALEM HEALTHCARE / Novant Health Winston Salem Health Care Chemo Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340014CF
Medicare Provider Number
340014
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/9/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/16/2015
Last Recertification Date
8/10/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
Novant Health
Geoffrey Gardner, SVP Finance
(336) 718-2078
Primary Contact
Novant Health
Elizabeth Anne Corazzo, Manager Pharmacy 340B
(336) 277-0301
Addresses
Street Address
250 CHARLOIS BLVD
WINSTON SALEM, NC 27103-1508
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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