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DSH340069AX WAKEMED (Terminated)
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Main Details
Name
WAKEMED
Subdivision Name
WakeMed Raleigh Medical Park - CV Testing - EKG
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340069AX
Medicare Provider Number
340069
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2015
Participating Start Date
1/1/2016
Participating Approval Date
12/1/2015
Last Recertification Date
11/6/2017
Termination Date
Termination Reason
10/1/2018
Other
Contacts
Authorizing Official
Wakemed
DONALD GINTZIG, President and CEO
(919) 350-8102
Primary Contact
WakeMed
Valerie Barlow, Exec Director of Clinical Svcs
(919) 350-8021
Addresses
Street Address
23 Sunnybrook Road
Raleigh, NC 27610
Billing Address
WakeMed Raleigh Medical Park
Attn: Accounts Payable
PO Box 14549
Raleigh, NC 27620
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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