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DSH180043L AdventHealth Manchester (Terminated)
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Main Details
Name
AdventHealth Manchester
Subdivision Name
MANCHESTER MEMORIAL HOSPITAL - MANCHESTER SURGERY CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH180043L
Medicare Provider Number
180043
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/31/2017
Last Recertification Date
8/24/2018
Termination Date
Termination Reason
10/1/2019
Site closure
Contacts
Authorizing Official
Memorial Hospital DBA AdventHealth Manchester
Daniel Camacho, CFO
(606) 598-1035
Primary Contact
Southeast Region
Christina Bayne, Interim 340B Regional Mgr
(828) 650-8298
Addresses
Street Address
485 MEMORIAL DRIVE
SUITE 3
MANCHESTER, KY 40962-6352
Billing Address
Manchester Memorial Hospital
c/o Adventist Health System
902 Inspiration Ave.
Suite 9100
Altamonte Springs, FL 32714
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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