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DSH340090N Johnston Health Services Corporation (Terminated)
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Main Details
Name
Johnston Health Services Corporation
Subdivision Name
Johnston Health - Clayton / Observation - 3rd Floor Bed Tower
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340090N
Medicare Provider Number
340090
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/16/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/24/2017
Last Recertification Date
9/6/2023
Termination Date
Termination Reason
7/1/2024
Other
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
2138 NC Hwy 42 W
Clayton, NC 27520
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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