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DSH360218 LICKING MEMORIAL HOSPITAL (Active)
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Main Details
Name
LICKING MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360218
Medicare Provider Number
360218
Additional Details
Current Program Status
Active
Registration Date
12/1/2005
Participating Start Date
12/1/2005
Participating Approval Date
12/1/2005
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Licking Memorial Hospital
Cynthia L. Webster, Chief Financial Officer
(220) 564-4518
Primary Contact
Licking Memorial hospital
Robert Merrill Fish, Jr., Pharmacy Business Manager
(220) 564-4598
Addresses
Street Address
1320 WEST MAIN STREET
NEWARK, OH 43055
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/26/2009- DOCUMENTS RECD TO CONFIRM ELIGIBLE DSH ADJ%
03/10/2009
May 2025
May 2025
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