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CH0511330 GOOD SAMARITAN HOSPITAL (Terminated)
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Main Details
Name
GOOD SAMARITAN HOSPITAL
Subdivision Name
Samaritan Homeless Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-008637
340B ID
CH0511330
Grant Number
H80CS00027
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2005
Participating Start Date
7/1/2005
Participating Approval Date
6/17/2005
Last Recertification Date
2/10/2015
Termination Date
Termination Reason
10/1/2015
Loss of qualifying grant/support
Contacts
Authorizing Official
Diane Cummins, Chief Operating Officer
(937) 734-6838
Primary Contact
Diane Cummins, Chief Operating Officer
(937) 734-6838
Addresses
Street Address
921 S Edwin C Moses Blvd
Dayton, OH 45417-3464
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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5/11/12 - Changed address from 41 CATHERINE STREET. 1/4/06 UPDATED ADDR (WAS 2222 PHILADELPHIA DRIVE ZIP: 45406)
05/11/2012
1/4/06 UPDATED ADDR (WAS 2222 PHILADELPHIA DRIVE ZIP: 45406)
01/08/2010
May 2025
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