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DSH340186 VIDANT BEAUFORT HOSPITAL (Terminated)
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Main Details
Name
VIDANT BEAUFORT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH340186
Medicare Provider Number
340186
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2021
Participating Start Date
7/1/2021
Participating Approval Date
5/6/2021
Last Recertification Date
8/30/2021
Termination Date
Termination Reason
1/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Duplin General Hospital, Inc. d/b/a Vidant Duplin Hospital
LUCINDA CRAWFORD, VICE PRESIDENT OF FINANCIAL SERVICES
(910) 296-2608
Primary Contact
East Carolina Health - Beaufort, Inc d/b/a Vidant Beafort Hospital
Andy Tingen, Pharmacy Manager
(252) 975-4293
Addresses
Street Address
628 E. 12TH STREET
WASHINGTON, NC 27889
Billing Address
Vidant Health Accounts Payable
PO Box 6028
Greenville, NC 27835-6028
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2017, terminated 4/1/2019. Reinstated 7/1/2021.
05/06/2021
10/5/16 Participating 4/1/2012 until terminated effective 10/1/2016, reinstated effective 1/1/2017
01/11/2017
10/5/16 Participating 4/1/2012 until terminated effective 10/1/2016, reinstated effective 1/1/2016
10/05/2016
3/7/12 received letter from FI and email stating interim CMS report was being accepted and now entity is eligible 3/1/12 Thank you for the information regarding your application to enter the 340B program. After reviewing the material we have received to date can you please send or answer the following questions at your earliest convenience in compliance with the deadlines listed in the initial email: 1. You send a letter that is addressed to Mr. Jim Peebles (I assume your Fiscal Intermediary) to show an interim cost reporting period of 9/15-11/30/2011. I will need Mr. Peebles letter stating this request was accepted and used for CMS purposes. 2. I will need a copy of the worksheet S (the signed copy of the wet ink page) 3. Please show where the child site Marian Sheppard Cancer Center appears on your Worksheet A as I do not see it, if it is listed as line 90 clinic, please send an unbundled listing showing costs that are specifically listed to this clinic. 2/29/12 sent initial email
03/07/2012
3/1/12 Thank you for the information regarding your application to enter the 340B program. After reviewing the material we have received to date can you please send or answer the following questions at your earliest convenience in compliance with the deadlines listed in the initial email: 1. You send a letter that is addressed to Mr. Jim Peebles (I assume your Fiscal Intermediary) to show an interim cost reporting period of 9/15-11/30/2011. I will need Mr. Peebles letter stating this request was accepted and used for CMS purposes. 2. I will need a copy of the worksheet S (the signed copy of the wet ink page) 3. Please show where the child site Marian Sheppard Cancer Center appears on your Worksheet A as I do not see it, if it is listed as line 90 clinic, please send an unbundled listing showing costs that are specifically listed to this clinic. 2/29/12 sent initial email
03/01/2012
2/29/12 sent initial email
02/29/2012
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