340B Drug Pricing Program Database


DSH360076AD ATRIUM MEDICAL CENTER (Active) - information as of 5/6/2025 12:02:17 AM

Main Details
ATRIUM MEDICAL CENTER
AMC HEART FAILURE CLINIC - CARDIOLOGY
Disproportionate Share Hospital
No
DSH360076AD
360076


Additional Details
Active
7/13/2023
10/1/2023
8/1/2023
8/26/2024

Contacts

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

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

Addresses

1 MEDICAL CENTER DRIVE
200
MIDDLETOWN, OH 45005

PREMIER HEALTH
110 N MAIN STREET
DAYTON, OH 45402


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
AL 1700950060
AK 1700950060
AZ 1700950060
AR 1700950060
CA 1700950060
CO 1700950060
CT 1700950060
DE 1700950060
FL 1700950060
GA 1700950060
HI 1700950060
ID 1700950060
IL 1700950060
IN 1700950060
IA 1700950060
KY 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
OH 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
DC 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 RoadTrentonOHActive
DSH360076ABChildDSHATRIUM MEDICAL CENTERAMC PHYSICAL THERAPY - LEBANON - THERAPY1697 Deerfield RoadLebanonOHActive
DSH360076ACChildDSHATRIUM MEDICAL CENTERSPORTS MEDICINE MIDDLETOWN - Hand Therapy - Therapy5750 Innovation DriveMiddletownOHActive
DSH360076ADChildDSHATRIUM MEDICAL CENTERAMC HEART FAILURE CLINIC - CARDIOLOGY1 MEDICAL CENTER DRIVEMIDDLETOWNOHActive
DSH360076AEChildDSHATRIUM MEDICAL CENTERAMC WOMENS CENTER - Oncology200 Medical Center DriveMiddletownOHActive
DSH360076BChildDSHATRIUM MEDICAL CENTERATRIUM HEALTH CENTER MASON / Excel Corporate Care7450S MASON MONTGOMERY RDMASONOHTerminated
DSH360076CChildDSHATRIUM MEDICAL CENTERBreast Center200 Medical Center DriveMiddletownOHActive
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 DriveMiddletownOHActive
DSH360076NChildDSHATRIUM MEDICAL CENTERWound Care Center / Hyperbaric Services200 Medical Center DrMiddletownOHActive
DSH360076PChildDSHATRIUM MEDICAL CENTERMATERNAL HEALTH CLINIC100 CAMPUS LOOP RDMIDDLETOWNOHActive
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 RDTRENTONOHActive
DSH360076TChildDSHATRIUM MEDICAL CENTERAMC SWO SC RADIOLOGY - Radiology-Diagnostic295 N Breiel BlvdMiddletownOHTerminated
DSH360076UChildDSHATRIUM MEDICAL CENTERAMC SWO SC OR - Operating Room295 N Breiel BlvdMiddletownOHActive
DSH360076VChildDSHATRIUM MEDICAL CENTERSPORTS MEDICINE MIDDLETOWN - Physical Therapy5750 Innovation DriveMiddletownOHActive
DSH360076WChildDSHATRIUM MEDICAL CENTERAMC SWO SC ANESTHESIA - Anesthesiology295 N Breiel BlvdMiddletownOHActive
DSH360076XChildDSHATRIUM MEDICAL CENTERATRIUM SPORTS MED AND PT - FRANKLIN - Physical Therapy909 E 2ND STFRANKLINOHActive
DSH360076YChildDSHATRIUM MEDICAL CENTERAMC SWO SC PREOP/PACU - Recovery Room295 N Breiel BlvdMiddletownOHActive
DSH360076ZChildDSHATRIUM MEDICAL CENTERATRIUM MEDICAL CENTER MASON / PHYSICAL THERAPY - THERAPY7450 South Mason Montgomery RoadMasonOHTerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingNPI: NumberInsertChange Request 170095006011/19/2024 7:29 PM
Medicaid BillingNPI: StateInsertChange Request KS11/19/2024 7:29 PM
Medicaid BillingNPI: NumberInsertChange Request 170095006011/19/2024 7:29 PM
Medicaid BillingNPI: StateInsertChange Request DC11/19/2024 7:29 PM
DetailsLast Recertification DateUpdateRecertification 8/26/2024 10:51:16 AM8/26/2024 10:51 AM
DetailsStateUpdate ApprovedActive10/1/2023 12:01 AM
ContactsSigned ByInsertNew Registration Ganger, Craig Allen Chief Financial Officer Premier Health 93749999888/1/2023 8:51 AM
Details340B IDUpdateNew Registration DSH360076AD8/1/2023 8:51 AM
DetailsEntity SubnameUpdateNew RegistrationAMC HEART FAILURE CLINICAMC HEART FAILURE CLINIC - CARDIOLOGY8/1/2023 8:51 AM
DatesParticipating Approval DateUpdateNew Registration 8/1/2023 8:51:39 AM8/1/2023 8:51 AM
DetailsStateUpdateNew RegistrationPendingApproved8/1/2023 8:51 AM
DatesSigned By DateUpdateNew Registration 7/31/2023 7:51:09 AM8/1/2023 8:51 AM
DatesStart DateUpdateNew Registration 10/1/2023 12:00:00 AM8/1/2023 8:51 AM
AddressesMain AddressInsertNew Registration  1 MEDICAL CENTER DRIVE 200 MIDDLETOWN, OH 450057/13/2023 9:33 AM
AddressesBilling AddressInsertNew Registration PREMIER HEALTH 110 N MAIN STREET DAYTON, OH 454027/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration AL7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration AK7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration AZ7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration AR7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration CA7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration CO7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration CT7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration DE7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration FL7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration GA7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration HI7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration ID7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration IL7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration IN7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration IA7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration KY7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration LA7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration ME7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration MD7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration MA7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration MI7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration MN7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration MS7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration MO7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration MT7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration NE7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration NV7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration NH7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration NJ7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration NM7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration NY7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration NC7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration ND7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration OH7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration OK7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration OR7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration PA7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration RI7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration SC7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration SD7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration TN7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration TX7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration UT7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration VT7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration VA7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration WA7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration WV7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration WI7/13/2023 9:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 17009500607/13/2023 9:33 AM
Medicaid BillingNPI: StateInsertNew Registration WY7/13/2023 9:33 AM
ContactsPrimary ContactInsertNew Registration STIDHAM, SHELLY 340B Coordinator Premier Health 93783857677/13/2023 9:33 AM
ContactsAuthorizing OfficialInsertNew Registration Ganger, Craig Allen Chief Financial Officer Premier Health 93749999887/13/2023 9:33 AM
DetailsAssistance Received From DateInsertNew Registration  7/13/2023 9:33 AM
DetailsAssistance Received To DateInsertNew Registration  7/13/2023 9:33 AM
DetailsLast Recertification DateInsertNew Registration  7/13/2023 9:33 AM
DetailsGrant NumberInsertNew Registration  7/13/2023 9:33 AM
Details340B IDInsertNew Registration  7/13/2023 9:33 AM
DetailsIs Authorizing Official EHB DataInsertNew Registration  7/13/2023 9:33 AM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  7/13/2023 9:33 AM
DetailsMedicare Provider NumberInsertNew Registration 3600767/13/2023 9:33 AM
DetailsEntity NameInsertNew Registration ATRIUM MEDICAL CENTER7/13/2023 9:33 AM
DetailsNOFO NumberInsertNew Registration  7/13/2023 9:33 AM
DetailsProgram CodeInsertNew Registration DSH7/13/2023 9:33 AM
DetailsEntity SubnameInsertNew Registration AMC HEART FAILURE CLINIC7/13/2023 9:33 AM
DatesParticipating Approval DateInsertNew Registration  7/13/2023 9:33 AM
DetailsStateInsertNew Registration Pending7/13/2023 9:33 AM
DatesRegistration DateInsertNew Registration 7/13/2023 9:33:32 AM7/13/2023 9:33 AM
DatesSigned By DateInsertNew Registration  7/13/2023 9:33 AM
DatesStart DateInsertNew Registration  7/13/2023 9:33 AM
TerminationsTermination CommentsInsertNew Registration  7/13/2023 9:33 AM
TerminationsTermination DateInsertNew Registration  7/13/2023 9:33 AM
TerminationsTermination Effective DateInsertNew Registration  7/13/2023 9:33 AM
TerminationsTermination ReasonInsertNew Registration  7/13/2023 9:33 AM