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DSH010039AL HUNTSVILLE HOSPITAL (Terminated)
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Main Details
Name
HUNTSVILLE HOSPITAL
Subdivision Name
Clinic for Breast Center - Breast Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH010039AL
Medicare Provider Number
010039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/10/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/25/2020
Last Recertification Date
9/2/2020
Termination Date
Termination Reason
12/1/2020
At request of covered entity
Contacts
Authorizing Official
Huntsville Hospital
Clinton Carter, CFO
(256) 265-8818
Primary Contact
Huntsville Hospital
Luona Wang, Business Manager of Pharmacy Services
(256) 265-6241
Addresses
Street Address
910 Adams St SE
Suite 110
Huntsville, AL 35801
Billing Address
Huntsville Hospital
101 Sivley Rd
Huntsville, AL 35801
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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