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DSH340090K Johnston Health Services Corporation (Active)
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Main Details
Name
Johnston Health Services Corporation
Subdivision Name
JOHNSTON HEALTH AMBULATORY IMAGING
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340090K
Medicare Provider Number
340090
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/15/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/19/2016
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Johnston Health Services Corporation
Ruth L Marler, COO/CNO
(919) 938-7383
Primary Contact
Johnston Health Services Corporation
David Willoughby, Director of Pharmacy Services
(919) 938-7288
Addresses
Street Address
514 N. BRIGHTLEAF BLVD
Suite 1302
SMITHFIELD, NC 27577
Billing Address
Johnston Health Services Corporation
509 N. Brightleaf Blvd
Smithfield, NC 27577
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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