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DSH340032Q GASTON MEMORIAL HOSPITAL (Active)
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Main Details
Name
GASTON MEMORIAL HOSPITAL
Subdivision Name
Mt. Holly Emergency Imaging Services - CT - Imaging Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340032Q
Medicare Provider Number
340032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2024
Participating Start Date
1/1/2025
Participating Approval Date
11/18/2024
Last Recertification Date
Contacts
Authorizing Official
Caromont Regional Medical Center
David O’Connor, CFO
(704) 834-2127
Primary Contact
CaroMont Regional Medical Center
Mark Chaparro, Pharmacy Director
(704) 834-2239
Addresses
Street Address
451 East Charlotte Ave
Mt. Holly, NC 28120
Billing Address
Gaston Memorial Hospital
Po Box 1747
Gastonia, NC 28053
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 3/15/2022; Terminated 1/1/2024; Reinstated 1/1/2025.
11/18/2024
April 2025
April 2025
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