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SCH490021-22 CENTRA HEALTH, INC (Terminated)
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Main Details
Name
CENTRA HEALTH, INC
Subdivision Name
Urology
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH490021-22
Medicare Provider Number
490021
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/5/2015
Last Recertification Date
9/10/2019
Termination Date
Termination Reason
10/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Centra Health, Inc.
Michael Elliott, SVP COO
(434) 200-4552
Primary Contact
Centra
Barbara J. Bryant, Managing Director Financial Regulatory Review
(434) 200-4714
Addresses
Street Address
1330 OAK LANE
Suite 203
LYNCHBURG, VA 24503-2513
Billing Address
Centra Health
3300 Rivermont Avenue
Lynchburg, VA 24503
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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