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DSH510013A REYNOLDS MEMORIAL HOSPITAL (Active)
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Main Details
Name
REYNOLDS MEMORIAL HOSPITAL
Subdivision Name
REYNOLDS MEMORIAL HOSPITAL INC - Cancer Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH510013A
Medicare Provider Number
510013
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2021
Participating Start Date
7/1/2021
Participating Approval Date
6/3/2021
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Reynolds Memorial Hospital
Alex Craig Inclan, CFO
(304) 843-3240
Primary Contact
Reynolds Memorial Hospital
Terry Kennon, Director of Pharmacy
(304) 843-3309
Addresses
Street Address
901 JEFFERSON AVE
GLEN DALE, WV 26038-1407
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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