Covered Entity Details

DSH360076K ATRIUM MEDICAL CENTER (Terminated) - information as of 4/29/2025 1:43:12 AM

Main Details

Name

ATRIUM MEDICAL CENTER

Subdivision Name

ATRIUM HEALTH CENTER MASON / Lab

Type

Disproportionate Share Hospital

Rural

340B ID

DSH360076K

Medicare Provider Number

360076

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/13/2017

Participating Start Date

4/1/2017

Participating Approval Date

2/24/2017

Last Recertification Date

8/31/2018

Termination Date
Termination Reason

4/1/2019
Site closure

Contacts

Authorizing Official

Premier Health
Scott Andrew Shelton, VP CFO
(937) 499-9989

Primary Contact

Premier Health
Jennifer Marie Ranly, Director, Reimbursement
(937) 499-5529

Addresses

Street Address

7450S MASON MONTGOMERY RD
MASON, OH 45040-7802

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
OH	5948505
		1700950060

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH360076A	Child	DSH	ATRIUM MEDICAL CENTER	Excel Occupational Health	4220 Grand Ave	Middletown	OH	Terminated
DSH360076AA	Child	DSH	ATRIUM MEDICAL CENTER	ATRIUM MEDICAL CENTER - TRENTON / Physical Therapy - Therapy	3590 Busenbark Road	Trenton	OH	Active
DSH360076AB	Child	DSH	ATRIUM MEDICAL CENTER	AMC PHYSICAL THERAPY - LEBANON - THERAPY	1697 Deerfield Road	Lebanon	OH	Active
DSH360076AC	Child	DSH	ATRIUM MEDICAL CENTER	SPORTS MEDICINE MIDDLETOWN - Hand Therapy - Therapy	5750 Innovation Drive	Middletown	OH	Active
DSH360076AD	Child	DSH	ATRIUM MEDICAL CENTER	AMC HEART FAILURE CLINIC - CARDIOLOGY	1 MEDICAL CENTER DRIVE	MIDDLETOWN	OH	Active
DSH360076AE	Child	DSH	ATRIUM MEDICAL CENTER	AMC WOMENS CENTER - Oncology	200 Medical Center Drive	Middletown	OH	Active
DSH360076B	Child	DSH	ATRIUM MEDICAL CENTER	ATRIUM HEALTH CENTER MASON / Excel Corporate Care	7450S MASON MONTGOMERY RD	MASON	OH	Terminated
DSH360076C	Child	DSH	ATRIUM MEDICAL CENTER	Breast Center	200 Medical Center Drive	Middletown	OH	Active
DSH360076D	Child	DSH	ATRIUM MEDICAL CENTER	SOUTHWEST OHIO SURGERY CENTER	295N BREIEL BLVD	MIDDLETOWN	OH	Terminated
DSH360076E	Child	DSH	ATRIUM MEDICAL CENTER	GRAND AVENUE IMAGING CENTER	4216 GRAND AVE	MIDDLETOWN	OH	Terminated
DSH360076F	Child	DSH	ATRIUM MEDICAL CENTER	ATRIUM HEALTH CENTER MASON / Women's Center	7450S MASON MONTGOMERY RD	MASON	OH	Terminated
DSH360076G	Child	DSH	ATRIUM MEDICAL CENTER	ATRIUM HEALTH CENTER MASON / Imaging	7450S MASON MONTGOMERY RD	MASON	OH	Terminated
DSH360076H	Child	DSH	ATRIUM MEDICAL CENTER	ATRIUM HEALTH CENTER - TRENTON / Cardiology	3590 BUSENBARK RD	TRENTON	OH	Terminated
DSH360076J	Child	DSH	ATRIUM MEDICAL CENTER	ATRIUM HEALTH CENTER MASON / Cardiology	7450S MASON MONTGOMERY RD	MASON	OH	Terminated
DSH360076K	Child	DSH	ATRIUM MEDICAL CENTER	ATRIUM HEALTH CENTER MASON / Lab	7450S MASON MONTGOMERY RD	MASON	OH	Terminated
DSH360076L	Child	DSH	ATRIUM MEDICAL CENTER	Infusion Center	501 Atrium Drive	Franklin	OH	Terminated
DSH360076M	Child	DSH	ATRIUM MEDICAL CENTER	Wound Care Center / Wound Care	200 Medical Center Drive	Middletown	OH	Active
DSH360076N	Child	DSH	ATRIUM MEDICAL CENTER	Wound Care Center / Hyperbaric Services	200 Medical Center Dr	Middletown	OH	Active
DSH360076P	Child	DSH	ATRIUM MEDICAL CENTER	MATERNAL HEALTH CLINIC	100 CAMPUS LOOP RD	MIDDLETOWN	OH	Active
DSH360076Q	Child	DSH	ATRIUM MEDICAL CENTER	ATRIUM HEALTH CENTER MASON / Emergency Department	7450S MASON MONTGOMERY RD	MASON	OH	Terminated
DSH360076R	Child	DSH	ATRIUM MEDICAL CENTER	DIABETES WELLNESS CENTER	4218 GRAND AVE	MIDDLETOWN	OH	Terminated
DSH360076S	Child	DSH	ATRIUM MEDICAL CENTER	ATRIUM HEALTH CENTER - TRENTON / Medical Imaging	3590 BUSENBARK RD	TRENTON	OH	Active
DSH360076T	Child	DSH	ATRIUM MEDICAL CENTER	AMC SWO SC RADIOLOGY - Radiology-Diagnostic	295 N Breiel Blvd	Middletown	OH	Terminated
DSH360076U	Child	DSH	ATRIUM MEDICAL CENTER	AMC SWO SC OR - Operating Room	295 N Breiel Blvd	Middletown	OH	Active
DSH360076V	Child	DSH	ATRIUM MEDICAL CENTER	SPORTS MEDICINE MIDDLETOWN - Physical Therapy	5750 Innovation Drive	Middletown	OH	Active
DSH360076W	Child	DSH	ATRIUM MEDICAL CENTER	AMC SWO SC ANESTHESIA - Anesthesiology	295 N Breiel Blvd	Middletown	OH	Active
DSH360076X	Child	DSH	ATRIUM MEDICAL CENTER	ATRIUM SPORTS MED AND PT - FRANKLIN - Physical Therapy	909 E 2ND ST	FRANKLIN	OH	Active
DSH360076Y	Child	DSH	ATRIUM MEDICAL CENTER	AMC SWO SC PREOP/PACU - Recovery Room	295 N Breiel Blvd	Middletown	OH	Active
DSH360076Z	Child	DSH	ATRIUM MEDICAL CENTER	ATRIUM MEDICAL CENTER MASON / PHYSICAL THERAPY - THERAPY	7450 South Mason Montgomery Road	Mason	OH	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/31/2019 12:00:00 AM	2/7/2019 2:01 PM
Details	State	Update	Termination Request	Active	To Be Terminated	2/7/2019 2:01 PM
Terminations	Termination Date	Update	Termination Request		4/1/2019 12:00:00 AM	2/7/2019 2:01 PM
Terminations	Termination Effective Date	Update	Termination Request		2/1/2019 12:00:00 AM	2/7/2019 2:01 PM
Terminations	Termination Reason	Update	Termination Request		Site closure	2/7/2019 2:01 PM
Contacts	Primary Contact	Update	Change Request	Aylor, Melany C. Reimbursement Analyst Premier Health 9374995662	Ranly, Jennifer Marie Director, Reimbursement Premier Health 9374995529	12/17/2018 3:15 PM
Details	Last Recertification Date	Update	Recertification	11/17/2017 10:52:13 AM	8/31/2018 2:33:38 PM	8/31/2018 2:33 PM
Contacts	Primary Contact	Update	Change Request	Johnson, Renee Director Premier Health 9374995519	Aylor, Melany C. Reimbursement Analyst Premier Health 9374995662	7/16/2018 12:31 PM
Contacts	Authorizing Official	Update	AO Change Request	DUNCAN, THOMAS CFO Premier Health 9374999988	Shelton, Scott Andrew VP CFO Premier Health 9374999989	6/7/2018 2:10 PM
Details	Last Recertification Date	Update	Recertification		11/17/2017 10:52:13 AM	11/17/2017 10:52 AM
Contacts	Authorizing Official	Update		DUNCAN, THOMAS CFO 9374999988	DUNCAN, THOMAS CFO Premier Health 9374999988	10/2/2017 11:14 AM
Contacts	Signed By	Update		DUNCAN, THOMAS CFO 9374999988	DUNCAN, THOMAS CFO Premier Health 9374999988	10/2/2017 11:14 AM
Contacts	Primary Contact	Update		Johnson, Renee Director 9374995519	Johnson, Renee Director Premier Health 9374995519	9/27/2017 9:52 AM
Contacts	Primary Contact	Insert			Johnson, Renee Director 9374995519	7/12/2017 6:04 PM
Contacts	Authorizing Official	Insert			DUNCAN, THOMAS CFO 9374999988	7/12/2017 3:44 PM
Contacts	Signed By	Insert			DUNCAN, THOMAS CFO 9374999988	7/12/2017 3:44 PM
Addresses	Main Address	Insert			7450S MASON MONTGOMERY RD MASON, OH 45040-7802	2/24/2017 1:34 PM
Dates	Participating Approval Date	Update			2/24/2017 12:00:00 AM	2/24/2017 1:30 PM
Details	State	Update		Pending	Active	2/24/2017 1:30 PM
Dates	Start Date	Update			4/1/2017 12:00:00 AM	2/24/2017 1:30 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_74834	DSH360076K	1/31/2017 12:03 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_74834	1/13/2017 12:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/13/2017 12:43 PM
Medicaid Billing	Medicaid: Number	Insert			5948505	1/13/2017 12:43 PM
Medicaid Billing	Medicaid: State	Insert			OH	1/13/2017 12:43 PM
Medicaid Billing	NPI: Number	Insert			1700950060	1/13/2017 12:43 PM
Details	Last Recertification Date	Insert				1/13/2017 12:43 PM
Details	Grant Number	Insert				1/13/2017 12:43 PM
Details	340B ID	Insert				1/13/2017 12:43 PM
Details	Is Authorizing Official EHB Data	Insert				1/13/2017 12:43 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/13/2017 12:43 PM
Details	Medicare Provider Number	Insert			360076	1/13/2017 12:43 PM
Details	Entity Name	Insert			ATRIUM MEDICAL CENTER	1/13/2017 12:43 PM
Details	Program Code	Insert			DSH	1/13/2017 12:43 PM
Details	Entity Subname	Insert			ATRIUM HEALTH CENTER MASON / Lab	1/13/2017 12:43 PM
Dates	Participating Approval Date	Insert				1/13/2017 12:43 PM
Details	State	Insert			Pending	1/13/2017 12:43 PM
Dates	Registration Date	Insert			1/13/2017 12:00:00 AM	1/13/2017 12:43 PM
Dates	Signed By Date	Insert			1/13/2017 12:00:00 AM	1/13/2017 12:43 PM
Dates	Start Date	Insert				1/13/2017 12:43 PM
Terminations	Termination Comments	Insert				1/13/2017 12:43 PM
Terminations	Termination Date	Insert				1/13/2017 12:43 PM
Terminations	Termination Effective Date	Insert				1/13/2017 12:43 PM
Terminations	Termination Reason	Insert				1/13/2017 12:43 PM