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DSH340003D NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY (Terminated)
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Main Details
Name
NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY
Subdivision Name
MOUNT AIRY OB-GYN
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH340003D
Medicare Provider Number
340003
Outpatient Facility Provider Number
232278
Additional Details
Current Program Status
Terminated
Registration Date
4/6/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/5/2016
Last Recertification Date
9/5/2018
Termination Date
Termination Reason
4/1/2019
DSH percentage below statutory minimum
Contacts
Authorizing Official
Northern Hospital
Robin Hodgin, VP Patient Care Services
(336) 719-7019
Primary Contact
Northern Hospital of Surry County
DARRELL ESTES, DIRECTOR OF PHARMACY
(336) 719-7120
Addresses
Street Address
510 S. SOUTH STREET
MOUNT AIRY, NC 27030
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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5/5/16 Participating 7/1/14 until terminated effective 7/1/15, reinstated 7/1/16;
05/05/2016
May 2025
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