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DSH510029H THOMAS MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
THOMAS MEMORIAL HOSPITAL
Subdivision Name
Thomas Care Clinic-WVSU
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH510029H
Medicare Provider Number
510029
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/8/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/12/2016
Last Recertification Date
9/1/2016
Termination Date
Termination Reason
10/1/2017
Site closure
Contacts
Authorizing Official
Thomas Memorial Hospital
Brian Ulery, Chief Operating Officer
(304) 766-3445
Primary Contact
Thomas Health
Brian L Ulery, Chief Operating Officer (COO)
(304) 766-3445
Addresses
Street Address
301 Washington Ave Suite 004
Dunbar, WV 25064-3420
Billing Address
Thomas Memorial Hospital
4605 MacCorkle Ave SW
South Charleston, WV 25309
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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