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DSH360365 AVITA ONTARIO HOSPITAL (Active)
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Main Details
Name
AVITA ONTARIO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360365
Medicare Provider Number
360365
Additional Details
Current Program Status
Active
Registration Date
4/8/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/9/2024
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Avita Health System
ERIC DRAIME, CHIEF FINANCIAL OFFICER
(419) 468-0501
Primary Contact
Avita Health System
Christina Barnes, Director of Pharmacy
(419) 468-0541
Addresses
Street Address
715 RICHLAND MALL
ONTARIO, OH 44906
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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