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RRC360147-59 MARIETTA MEMORIAL HOSPITAL (Approved)
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Main Details
Name
MARIETTA MEMORIAL HOSPITAL
Subdivision Name
PRIMARY CARE
Type
Rural Referral Center
Rural
Yes
340B ID
RRC360147-59
Medicare Provider Number
360147
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/10/2025
Participating Start Date
7/1/2025
Participating Approval Date
5/8/2025
Last Recertification Date
Contacts
Authorizing Official
Marietta Memorial Hospital
Doug Full, Director of Finance
(740) 374-1698
Primary Contact
Marietta Memorial Hospital
David Layne, 340B Pharmacy Analyst
(606) 922-3796
Addresses
Street Address
807 Farson Street
Suite 203 A
203 A
Belpre, OH 45714
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (07/01/2016) until terminated effective date:(04/01/2019); reinstatement effective date: (07/1/2025)
05/08/2025
June 2025
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