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DSH490007V SENTARA NORFOLK GENERAL HOSPITAL (Terminated)
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Main Details
Name
SENTARA NORFOLK GENERAL HOSPITAL
Subdivision Name
SNGH Dermatology - Kempsville - 801 0192
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH490007V
Medicare Provider Number
490007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/7/2020
Participating Start Date
7/1/2020
Participating Approval Date
6/1/2020
Last Recertification Date
8/31/2023
Termination Date
Termination Reason
1/1/2024
Site closure
Contacts
Authorizing Official
Sentara Norfolk General Hospital
Liisa K Ortegon, President
(757) 388-3240
Primary Contact
Sentara Norfolk General Hospital
Tim Jennings, VP Pharmacy
(757) 388-3443
Addresses
Street Address
850 Kempsville Road
Suite 100D
Norfolk, VA 23502
Billing Address
Sentara Norfolk General Hospital
6015 Poplar Hall Drive
Norfolk, VA 23502
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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