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DSH510022DG CHARLESTON AREA MEDICAL CENTER (CAMC) (Terminated)
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Main Details
Name
CHARLESTON AREA MEDICAL CENTER (CAMC)
Subdivision Name
Pediatric Clinic / Pediatric Service
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH510022DG
Medicare Provider Number
510022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/26/2017
Last Recertification Date
9/10/2020
Termination Date
Termination Reason
4/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Charleston Area Medical Center
STEPHEN BELL, VICE PRESIDENT - FINANCE
(304) 388-6251
Primary Contact
Vandalia Health
Brian Sayre, VP of Pharmacy Services
(304) 388-8917
Addresses
Street Address
800 Pennsylvania Avenue
Charleston, WV 25302
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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