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DSH310092D CAPITAL HEALTH SYSTEM - FULD (Active)
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Main Details
Name
CAPITAL HEALTH SYSTEM - FULD
Subdivision Name
Pediatric Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH310092D
Medicare Provider Number
310092
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/17/2017
Participating Start Date
7/1/2017
Participating Approval Date
5/10/2017
Last Recertification Date
9/9/2024
Contacts
Authorizing Official
Capital Health System., Inc.
Laura McGuire, CCO
(609) 394-6783
Primary Contact
Capital Health System, Inc.
Kenneth John Bevenour, Director of Pharmacy
(609) 815-7657
Addresses
Street Address
433 Bellevue Ave
Trenton, NJ 08618
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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