340B Drug Pricing Program Database


DSH360076V ATRIUM MEDICAL CENTER (ToBeTerminated) - information as of 6/15/2025 6:07:02 AM

Main Details
ATRIUM MEDICAL CENTER
SPORTS MEDICINE MIDDLETOWN - Physical Therapy
Disproportionate Share Hospital
No
DSH360076V
360076


Additional Details
ToBeTerminated
7/8/2020
10/1/2020
8/18/2020
8/23/2024

7/1/2025
DSH percentage below statutory minimum

Contacts

Premier Health
Craig Allen Ganger, Chief Financial Officer
(937) 499-9988

Premier Health
SHELLY STIDHAM, 340B Coordinator
(937) 838-5767

Addresses

5750 Innovation Drive
Middletown, OH 45005

Atrium Medical Center
110 North Main Street
Dayton, OH 45402


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
Participated starting 10/1/2018, terminated 7/1/2019. Reinstated 10/1/2020.08/12/2020
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
KY 1700950060
IN 1700950060
OH 1700950060
AL 1700950060
AK 1700950060
AZ 1700950060
AR 1700950060
CA 1700950060
CO 1700950060
CT 1700950060
DE 1700950060
DC 1700950060
FL 1700950060
GA 1700950060
HI 1700950060
ID 1700950060
IL 1700950060
IA 1700950060
LA 1700950060
ME 1700950060
MD 1700950060
MA 1700950060
MI 1700950060
MN 1700950060
MS 1700950060
MO 1700950060
MT 1700950060
NE 1700950060
NV 1700950060
NH 1700950060
NJ 1700950060
NM 1700950060
NY 1700950060
NC 1700950060
ND 1700950060
OK 1700950060
OR 1700950060
PA 1700950060
RI 1700950060
SC 1700950060
SD 1700950060
TN 1700950060
TX 1700950060
UT 1700950060
VT 1700950060
VA 1700950060
WA 1700950060
WV 1700950060
WI 1700950060
WY 1700950060
KS 1700950060
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH360076AChildDSHATRIUM MEDICAL CENTERExcel Occupational Health4220 Grand AveMiddletownOHTerminated
DSH360076AAChildDSHATRIUM MEDICAL CENTERATRIUM MEDICAL CENTER - TRENTON / Physical Therapy - Therapy3590 Busenbark RoadTrentonOHToBeTerminated
DSH360076ABChildDSHATRIUM MEDICAL CENTERAMC PHYSICAL THERAPY - LEBANON - THERAPY1697 Deerfield RoadLebanonOHToBeTerminated
DSH360076ACChildDSHATRIUM MEDICAL CENTERSPORTS MEDICINE MIDDLETOWN - Hand Therapy - Therapy5750 Innovation DriveMiddletownOHToBeTerminated
DSH360076ADChildDSHATRIUM MEDICAL CENTERAMC HEART FAILURE CLINIC - CARDIOLOGY1 MEDICAL CENTER DRIVEMIDDLETOWNOHToBeTerminated
DSH360076AEChildDSHATRIUM MEDICAL CENTERAMC WOMENS CENTER - Oncology200 Medical Center DriveMiddletownOHToBeTerminated
DSH360076BChildDSHATRIUM MEDICAL CENTERATRIUM HEALTH CENTER MASON / Excel Corporate Care7450S MASON MONTGOMERY RDMASONOHTerminated
DSH360076CChildDSHATRIUM MEDICAL CENTERBreast Center200 Medical Center DriveMiddletownOHToBeTerminated
DSH360076DChildDSHATRIUM MEDICAL CENTERSOUTHWEST OHIO SURGERY CENTER295N BREIEL BLVDMIDDLETOWNOHTerminated
DSH360076EChildDSHATRIUM MEDICAL CENTERGRAND AVENUE IMAGING CENTER4216 GRAND AVEMIDDLETOWNOHTerminated
DSH360076FChildDSHATRIUM MEDICAL CENTERATRIUM HEALTH CENTER MASON / Women's Center7450S MASON MONTGOMERY RDMASONOHTerminated
DSH360076GChildDSHATRIUM MEDICAL CENTERATRIUM HEALTH CENTER MASON / Imaging7450S MASON MONTGOMERY RDMASONOHTerminated
DSH360076HChildDSHATRIUM MEDICAL CENTERATRIUM HEALTH CENTER - TRENTON / Cardiology3590 BUSENBARK RDTRENTONOHTerminated
DSH360076JChildDSHATRIUM MEDICAL CENTERATRIUM HEALTH CENTER MASON / Cardiology7450S MASON MONTGOMERY RDMASONOHTerminated
DSH360076KChildDSHATRIUM MEDICAL CENTERATRIUM HEALTH CENTER MASON / Lab7450S MASON MONTGOMERY RDMASONOHTerminated
DSH360076LChildDSHATRIUM MEDICAL CENTERInfusion Center501 Atrium DriveFranklinOHTerminated
DSH360076MChildDSHATRIUM MEDICAL CENTERWound Care Center / Wound Care200 Medical Center DriveMiddletownOHToBeTerminated
DSH360076NChildDSHATRIUM MEDICAL CENTERWound Care Center / Hyperbaric Services200 Medical Center DrMiddletownOHToBeTerminated
DSH360076PChildDSHATRIUM MEDICAL CENTERMATERNAL HEALTH CLINIC100 CAMPUS LOOP RDMIDDLETOWNOHToBeTerminated
DSH360076QChildDSHATRIUM MEDICAL CENTERATRIUM HEALTH CENTER MASON / Emergency Department7450S MASON MONTGOMERY RDMASONOHTerminated
DSH360076RChildDSHATRIUM MEDICAL CENTERDIABETES WELLNESS CENTER4218 GRAND AVEMIDDLETOWNOHTerminated
DSH360076SChildDSHATRIUM MEDICAL CENTERATRIUM HEALTH CENTER - TRENTON / Medical Imaging3590 BUSENBARK RDTRENTONOHToBeTerminated
DSH360076TChildDSHATRIUM MEDICAL CENTERAMC SWO SC RADIOLOGY - Radiology-Diagnostic295 N Breiel BlvdMiddletownOHTerminated
DSH360076UChildDSHATRIUM MEDICAL CENTERAMC SWO SC OR - Operating Room295 N Breiel BlvdMiddletownOHToBeTerminated
DSH360076VChildDSHATRIUM MEDICAL CENTERSPORTS MEDICINE MIDDLETOWN - Physical Therapy5750 Innovation DriveMiddletownOHToBeTerminated
DSH360076WChildDSHATRIUM MEDICAL CENTERAMC SWO SC ANESTHESIA - Anesthesiology295 N Breiel BlvdMiddletownOHToBeTerminated
DSH360076XChildDSHATRIUM MEDICAL CENTERATRIUM SPORTS MED AND PT - FRANKLIN - Physical Therapy909 E 2ND STFRANKLINOHToBeTerminated
DSH360076YChildDSHATRIUM MEDICAL CENTERAMC SWO SC PREOP/PACU - Recovery Room295 N Breiel BlvdMiddletownOHToBeTerminated
DSH360076ZChildDSHATRIUM MEDICAL CENTERATRIUM MEDICAL CENTER MASON / PHYSICAL THERAPY - THERAPY7450 South Mason Montgomery RoadMasonOHTerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 5/31/2025 12:00:00 AM6/5/2025 7:46 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated6/5/2025 7:46 AM
TerminationsTermination DateUpdateTermination Request 7/1/2025 12:00:00 AM6/5/2025 7:46 AM
TerminationsTermination Effective DateUpdateTermination Request 6/1/2025 12:00:00 AM6/5/2025 7:46 AM
TerminationsTermination ReasonUpdateTermination Request DSH percentage below statutory minimum6/5/2025 7:46 AM
Medicaid BillingNPI: NumberInsertChange Request 170095006011/19/2024 7:25 PM
Medicaid BillingNPI: StateInsertChange Request KS11/19/2024 7:25 PM
DetailsLast Recertification DateUpdateRecertification9/1/2023 2:54:06 PM8/23/2024 8:10:30 AM8/23/2024 8:10 AM
DetailsLast Recertification DateUpdateRecertification9/7/2022 9:35:47 AM9/1/2023 2:54:06 PM9/1/2023 2:54 PM
Medicaid BillingNPI: NumberDeleteChange Request1700950060 (KS) 6/15/2023 8:36 AM
DetailsLast Recertification DateUpdateRecertification8/25/2021 5:57:02 PM9/7/2022 9:35:47 AM9/7/2022 9:35 AM
Medicaid BillingMedicaid: NumberDeleteRecertification01540061 (KY) 8/25/2021 5:57 PM
Medicaid BillingMedicaid: NumberDeleteRecertification100034650A (IN) 8/25/2021 5:57 PM
Medicaid BillingMedicaid: NumberDeleteRecertification5948505 (OH) 8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification KY8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification IN8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification OH8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification AL8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification AK8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification AZ8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification AR8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification CA8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification CO8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification CT8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification DE8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification DC8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification FL8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification GA8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification HI8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification ID8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification IL8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification IA8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification KS8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification LA8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification ME8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification MD8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification MA8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification MI8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification MN8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification MS8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification MO8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification MT8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification NE8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification NV8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification NH8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification NJ8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification NM8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification NY8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification NC8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification ND8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification OK8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification OR8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification PA8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification RI8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification SC8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification SD8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification TN8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification TX8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification UT8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification VT8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification VA8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification WA8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification WV8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification WI8/25/2021 5:57 PM
Medicaid BillingNPI: NumberInsertRecertification 17009500608/25/2021 5:57 PM
Medicaid BillingNPI: StateInsertRecertification WY8/25/2021 5:57 PM
Medicaid BillingNPI: NumberDeleteRecertification1700950060 ( ) 8/25/2021 5:57 PM
DetailsLast Recertification DateUpdateRecertification 8/25/2021 5:57:02 PM8/25/2021 5:57 PM
ContactsPrimary ContactUpdateChange RequestRanly, Jennifer Marie Director, Reimbursement Premier Health 9374995529STIDHAM, SHELLY 340B Coordinator Premier Health 93783857673/8/2021 12:02 PM
ContactsAuthorizing OfficialUpdateAO Change RequestShelton, Scott Andrew VP CFO Premier Health 9374999989Ganger, Craig Allen Chief Financial Officer Premier Health 937499998812/21/2020 9:25 AM
DetailsStateUpdate ApprovedActive10/1/2020 12:01 AM
AddressesBilling AddressInsertReinstatement Atrium Medical Center 110 North Main Street Dayton, OH 454028/18/2020 8:42 AM
Medicaid BillingMedicaid: Is PrimaryInsertReinstatement False8/18/2020 8:42 AM
Medicaid BillingMedicaid: NumberInsertReinstatement 015400618/18/2020 8:42 AM
Medicaid BillingMedicaid: StateInsertReinstatement KY8/18/2020 8:42 AM
Medicaid BillingMedicaid: Is PrimaryInsertReinstatement False8/18/2020 8:42 AM
Medicaid BillingMedicaid: NumberInsertReinstatement 100034650A8/18/2020 8:42 AM
Medicaid BillingMedicaid: StateInsertReinstatement IN8/18/2020 8:42 AM
DatesLast Date That 340B Drugs PurchasedUpdateReinstatement5/31/2019 12:00:00 AM 8/18/2020 8:42 AM
DatesParticipating Approval DateUpdateReinstatement7/19/2018 3:06:16 PM8/18/2020 8:42:19 AM8/18/2020 8:42 AM
DetailsStateUpdateReinstatementTerminatedApproved8/18/2020 8:42 AM
DatesRegistration DateUpdateReinstatement7/11/2018 4:44:30 PM7/8/2020 12:04:19 PM8/18/2020 8:42 AM
DatesSigned By DateUpdateReinstatement7/12/2018 8:58:01 AM7/8/2020 1:35:37 PM8/18/2020 8:42 AM
DatesStart DateUpdateReinstatement10/1/2018 12:00:00 AM10/1/2020 12:00:00 AM8/18/2020 8:42 AM
TerminationsTermination DateUpdateReinstatement7/1/2019 12:00:00 AM 8/18/2020 8:42 AM
TerminationsTermination Effective DateUpdateReinstatement6/1/2019 12:00:00 AM 8/18/2020 8:42 AM
TerminationsTermination ReasonUpdateReinstatementDSH percentage below statutory minimum 8/18/2020 8:42 AM
DetailsComments PublicInsertReinstatement Participated starting 10/1/2018, terminated 7/1/2019. Reinstated 10/1/2020.8/12/2020 9:12 AM
DetailsStateUpdate To Be TerminatedTerminated7/1/2019 12:05 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 5/31/2019 12:00:00 AM6/3/2019 10:23 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated6/3/2019 10:23 AM
TerminationsTermination DateUpdateTermination Request 7/1/2019 12:00:00 AM6/3/2019 10:23 AM
TerminationsTermination Effective DateUpdateTermination Request 6/1/2019 12:00:00 AM6/3/2019 10:23 AM
TerminationsTermination ReasonUpdateTermination Request DSH percentage below statutory minimum6/3/2019 10:23 AM
ContactsPrimary ContactUpdateChange RequestAylor, Melany C. Reimbursement Analyst Premier Health 9374995662Ranly, Jennifer Marie Director, Reimbursement Premier Health 937499552912/17/2018 3:18 PM
DetailsStateUpdate ApprovedActive10/1/2018 12:05 AM
ContactsPrimary ContactUpdateChange RequestJohnson, Renee Director Premier Health 9374995519Aylor, Melany C. Reimbursement Analyst Premier Health 93749956628/31/2018 2:19 PM
ContactsSigned ByInsertNew Registration Shelton, Scott Andrew VP CFO Premier Health 93749999897/19/2018 3:06 PM
Details340B IDUpdateNew Registration DSH360076V7/19/2018 3:06 PM
DetailsEntity SubnameUpdateNew RegistrationSPORTS MEDICINE MIDDLETOWNSPORTS MEDICINE MIDDLETOWN - Physical Therapy7/19/2018 3:06 PM
DatesParticipating Approval DateUpdateNew Registration 7/19/2018 3:06:16 PM7/19/2018 3:06 PM
DetailsStateUpdateNew RegistrationPendingApproved7/19/2018 3:06 PM
DatesSigned By DateUpdateNew Registration 7/12/2018 8:58:01 AM7/19/2018 3:06 PM
DatesStart DateUpdateNew Registration 10/1/2018 12:00:00 AM7/19/2018 3:06 PM
AddressesMain AddressInsertNew Registration  5750 Innovation Drive Middletown, OH 450057/11/2018 4:44 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/11/2018 4:44 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 59485057/11/2018 4:44 PM
Medicaid BillingMedicaid: StateInsertNew Registration OH7/11/2018 4:44 PM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/11/2018 4:44 PM
ContactsPrimary ContactInsertNew Registration Johnson, Renee Director Premier Health 93749955197/11/2018 4:44 PM
ContactsAuthorizing OfficialInsertNew Registration Shelton, Scott Andrew VP CFO Premier Health 93749999897/11/2018 4:44 PM
DetailsLast Recertification DateInsertNew Registration  7/11/2018 4:44 PM
DetailsGrant NumberInsertNew Registration  7/11/2018 4:44 PM
Details340B IDInsertNew Registration  7/11/2018 4:44 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  7/11/2018 4:44 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  7/11/2018 4:44 PM
DetailsMedicare Provider NumberInsertNew Registration 3600767/11/2018 4:44 PM
DetailsEntity NameInsertNew Registration ATRIUM MEDICAL CENTER7/11/2018 4:44 PM
DetailsProgram CodeInsertNew Registration DSH7/11/2018 4:44 PM
DetailsEntity SubnameInsertNew Registration SPORTS MEDICINE MIDDLETOWN7/11/2018 4:44 PM
DatesParticipating Approval DateInsertNew Registration  7/11/2018 4:44 PM
DetailsStateInsertNew Registration Pending7/11/2018 4:44 PM
DatesRegistration DateInsertNew Registration 7/11/2018 4:44:30 PM7/11/2018 4:44 PM
DatesSigned By DateInsertNew Registration  7/11/2018 4:44 PM
DatesStart DateInsertNew Registration  7/11/2018 4:44 PM
TerminationsTermination CommentsInsertNew Registration  7/11/2018 4:44 PM
TerminationsTermination DateInsertNew Registration  7/11/2018 4:44 PM
TerminationsTermination Effective DateInsertNew Registration  7/11/2018 4:44 PM
TerminationsTermination ReasonInsertNew Registration  7/11/2018 4:44 PM