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DSH510029L Thomas Memorial Hospital (Terminated)
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Main Details
Name
Thomas Memorial Hospital
Subdivision Name
TMH Family Practice Associates
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH510029L
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
12/4/2017
Termination Date
Termination Reason
7/1/2018
Site closure
Contacts
Authorizing Official
Thomas Memorial Hospital
Brian Ulery, Chief Operating Officer
(304) 766-3445
Primary Contact
Thomas Memorial Hospital
Ken Priddy, 340B Program Director
(304) 766-4320
Addresses
Street Address
500 Poplar St Suite 304
South Charleston, WV 25309-1473
Billing Address
Thomas Memorial Hospital
4605 MacCorkle Ave SW
South Charleston, WV 25309-1311
Comments
Medicaid Billing
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